Appropriateness of Surgical Antibiotic Prophylaxis in a Tertiary Care Teaching Hospital in Central India: A Retrospective Analysis

Abstract

Surgical antibiotic prophylaxis (SAP) has been a boon in the prevention of surgical site infections (SSIs). This study was conducted to assess and evaluate the selection, timing, and duration of administration of SAP and their compliance with national and international guidelines in a tertiary care teaching hospital in India.This retrospective study included the data collected from the central records department in a tertiary care teaching hospital on major surgeries conducted between January 1, 2018, and December 31, 2018, from the departments of ENT, general surgery, orthopedic surgery, and obstetrics and gynecology. The data was analyzed for the appropriateness of their indication for SAP administration, choice, timing, and duration of antibiotics, and compliance with the American Society of Health-System Pharmacists (ASHP) and Indian Council of Medical Research (ICMR) guidelines. Results and interpretationOut of the total 394 case records included, only 2.53% (n = 10) of the cases were given an appropriate antibiotic. The duration of SAP was appropriate only in 6.53% (n = 24), and the timing of SAP administration was appropriate only in 50.76% (n = 204). The most commonly used antibiotic was ceftriaxone (pre-operative 58.12% (n = 229) and post-operative 43.14% (n = 170)). Major inappropriateness was observed in the selection of antibiotics which may be attributed to the non-availability of cefazolin in the institute. The inappropriateness of the duration of the SAP may be attributed to the extra precautions taken by the treating physicians to prevent SSIs. The overall compliance of the surgical cases with respect to the ASHP and ICMR guidelines was less than 1%. ConclusionThis study identified the lacuna between the guidelines for SAP and the clinical application of the same. It also identified the areas where quality improvement was needed which can be improved by implementing antimicrobial stewardship, especially the choice and the duration of SAP administration.

Comparative study of preoperative prophylactic antibiotic versus no antibiotic in patients undergoing elective laparoscopic cholecystectomy

“…Moving forward, a cautious approach to antibiotic prophylaxis tailored to individual patient characteristics and surgical risk factors is warranted to optimize patient care while minimizing the risks of antimicrobial resistance. 17,18 Our study findings and similar findings from other studies mentioned collectively underscore the notion that antibiotic prophylaxis may not confer significant additional benefits in terms of preventing SSIs or reducing postoperative morbidity in laparoscopic cholecystectomy patients especially in patients with low risk. 19 Furthermore, our study adds to the growing body of evidence highlighting the potential risks associated with routine antibiotic use in surgical practice.…”