Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infections at Ethiopian Tertiary-Care Teaching Hospital

Abstract

Background:Surgical site infections (SSIs) are infections that develop within 30 days after an operation or surveillance of surgical wound infection implementation within 90 days after surgery when an implant is placed. The objective of this study was to assess preoperative and postoperative antimicrobial use in St. Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.Methods:A hospital-based cross-sectional study was undertaken in surgery wards of SPHMMC for 4 months by reviewing 413 patients’ charts. All patients 13 years and older who were admitted and underwent different types of surgical procedures were included in the study. Epi info 7 was used for data entry, and then data were exported to Statistical Package for Social Sciences (SPSS) version 20.0 software for analysis. Descriptive analyses were computed and rate of SSI was calculated in this study. Moreover, bivariate analysis was done to examine the relationship between the outcome variable and predictor variables with a value of P < .2 retained for subsequent multivariate analyses using multiple logistic regressions. P value of <.05 was considered as statistically significant.Results:Out of 413 patients, 152 (36.8%) were operated for general surgery, and the remaining were for other types of surgeries. Most of the patients, 196 (79.7%), were managed by a single surgical antibiotic agent, followed by 2 agents (20.3%) for surgical prophylaxis indication. Surgical site infections occurred in 46 (11.1%) patients before discharge from the hospital. In those patients who need treatment for SSIs, almost half of them (49.5%) received combination therapy of ceftriaxone and metronidazole. Emergency surgical cases were 2.647 times more likely to develop SSIs than the elective surgical cases (adjusted odds ratio [AOR] = 2.647; 95% confidence interval [CI] = 1.406-4.983; P = .003). Patients who did not receive antibiotic prophylaxis were 2.572 times more likely to develop SSIs compared to those who received antibiotic prophylaxis (AOR = 2.572; 95% CI = 1.02-6.485; P = .045). Clean-contaminated and contaminated types of wound were a protective factor against SSI in our study.Conclusions:This study indicated that most of the patients (72.1%) received surgical antimicrobial prophylaxis. The overall incidence rate of SSIs was 11.1% in the studied hospital. Ceftriaxone was the most commonly used drug. Being not receiving prophylaxis, wound class, and surgery types were significantly associated with the development of SSI.

<p>Surgical Site Infections and Prophylaxis Antibiotic Use in the Surgical Ward of Public Hospital in Western Ethiopia: A Hospital-Based Retrospective Cross-Sectional Study</p>

“…One hundred (40.6%) of surgical antibiotic prophylaxis was given 30 minutes before incision in line with the recommended guideline. This is comparable to a study conducted by Alamrew et al 25 and Lee et al 44 According to American Family Physicians recommendations, prophylactic antibiotics should be initiated within 1 hour before surgical incision. 45 This supports our study finding as most of our study participants (208, 83.5%) received SAP within 1 hour before surgical incision.…”

“…These types of wound classes are suitable for the colonization and multiplication of different pathogens. Patients who did not get prophylactic antibiotics were seven (6.6) times more likely to develop SSI than patients who had prophylactic antibiotics, which is in line with Misganaw et al 28 and Alamrew et al 25 studies. Administering prophylactic antibiotic prevent colonization and spread of microbes.…”

“…Besides, a single antibiotic was used more than half of the surgical patients (60.7%), and ceftriaxone (45.4%) was the most frequently administered antibiotic. The finding is in contrast to Misganaw et al 28 and Alamrew et al 25 studies, which reported that a combination of ceftriaxone and metronidazole (47.46%) was the frequently used antibiotics. Such variation may be because of the different types of surgical procedures conducted among these studies and variation in the drug's accessibility.…”

“…34 The finding is higher than studies conducted by Lubega et al (16.4%), 35 Fisha et al (9.9%), 36 and Alamrew et al (11.1%). 25 The higher prevalence of SSI in our setting could be due to the lack of adequate infection control systems, poor practices, and inappropriate use of antibiotics. Likewise, the prevalence of SSI was higher than studies conducted by Mukagendaneza et al (10.9%) 37 and Ghali et al (8.6%).…”

“…1,22,24 30-50% of surgical patients prescribed prophylactic antibiotics, and of which, 30-90% was inappropriate. 25,26 Due to these irrational prophylactic antibiotic uses, increased medical care costs, prolonged hospitalization, superinfection, resistance, and adverse drug reaction were the frequently reported adverse effects. 18,22 Although several studies have been conducted on SSIs, with significant variations in different regions, there was a paucity of data in the Northwest part of Ethiopia.…”