Non-indicated use of prophylactic antibiotics in gynaecological surgery at an academic tertiary medical centre

Abstract

Surgical site infections (SSI) are the most common surgical complication. Perioperative antibiotics can reduce SSI when used properly. Despite guidelines from The American College of Obstetrics and Gynecology, non-indicated antibiotic use is widespread which exposes women to unnecessary risks. This study represents a quality improvement analysis assessing surgeon compliance with established guidelines regarding antibiotic use in gynaecological surgery. This is a single centre, retrospective study examining gynaecological procedures over two years. Cases were identified using Current Procedure Terminology codes. Perioperative antibiotics were used contrary to published guidelines in 199 of 1046 cases. Three variables were independently associated with inappropriate administration of perioperative antibiotics: entrance into abdominal cavity, higher EBL, and longer procedures. Impact statement Overuse of antibiotics has unintended consequences including allergic sequelae, extended length of hospital stay, increased healthcare costs, and the formation of antibiotic-resistant organisms. Antibiotic stewardship programmes have been shown to reduce the number of resistant pathogens, decrease incidence of Clostridium difficile colitis, and decrease length of hospital stay without increasing infection rates. Further outcomes-based research is needed regarding the use of antibiotic stewardship programmes in gynaecological surgery.

Controversies in Perioperative Antimicrobial Prophylaxis

“…Some of the more common reasons for using antibiotics unnecessarily in the perioperative setting include entrance into abdominal cavity, higher estimated blood loss, and longer procedures. 7 Although clinical guidelines for antibiotic prophylaxis across a wide array of surgical procedures have been proposed by a collaborative, multidisciplinary group of physicians and pharmacists, 8 widely cited, and reiterated, 9 clinicians often deviate from recommendations, especially when recommendations are based on weak data. The goal of this review is to highlight certain common but controversial topics in perioperative prophylaxis.…”

Assessment of perioperative antibiotic prophylaxis for gynecological surgeries at an academic hospital in Brazil

“…Joyce et al (2015) who studied 326 surgeries performed from 2012 to 2013 at tertiary care hospital found that PAP was used in 53.7% of procedures with no indication. More recently, Kremer et al (2018) analyzed 2,961 gynecological cases at a tertiary hospital and found that the overall proportion of preoperative antibiotic use for procedures in which antibiotics were not indicated was 19%. The study from Abubakar et al (2018) that evaluated compliance with surgical antibiotic prophylaxis in obstetrics and gynecological surgeries performed at 3 tertiary hospitals in Nigeria found the proportion of unnecessary antianaerobic combination to be as much as 89.3%.…”

“…In our study, the proportion of non-indicated preoperative antibiotics was significantly high, reaching almost 90%. In fact, there was no record of occurrences that could justify such use, for instance, prolonged surgery, unplanned entrance into the abdomen or excessive blood loss (Kremer et al, 2018). The overuse of antibiotics is well known to increase patient morbidity and healthcare costs.…”

“…Many studies have shown that irrational antibiotic use for PAP is still a common problem worldwide and it is frequently related to inappropriate selection of a broadspectrum antibiotic, prolonged duration of PAP, incorrect timing of prophylaxis and un-indicated use (Abubakar et al, 2018;Alemkere, 2018;Viamonte & Cherres, 2016;Wright et al, 2013). There is great variability in PAP used for gynecological surgeries and it frequently does not conform to the published recommendations (Abubakar et al, 2018, Joyce et al, 2015Kremer et al, 2018;Schimpf et al, 2015;Wright et al, 2013). The consequences of improper utilization include adverse drug reactions, development of bacterial resistance and increased healthcare costs (Burke, 2001;van Kasteren et al, 2003).…”

“…Therefore, the quality and use of PAP have been the subject of various studies (Abubakar et al, 2018;Burke, 2001;Joyce et al, 2015;Kremer et al, 2018;van Kasteren et al, 2003;Schimpf et al, 2015;Wright et al, 2013). Drug utilization studies could give useful insight about PAP patterns and provide valuable information for the improvement of PAP practices to ensure proper and effective administration of PAP.…”