Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms

Abstract

Background: Prophylactic antimicrobials have an important adjuvant role in the prevention of Surgical Site Infection (SSI), which is one of the most preventable causes of post-operative complication. In India, due to lack of adequate information and guidelines for antimicrobial prophylaxis in surgery there is a need to generate baseline data on the pattern of use of prophylactic antimicrobials. Aims & Objective: This study is aimed to analyze the pattern of surgical chemoprophylaxis and surgical site infection (SSI) rate in patients who underwent elective orthopedic surgical procedure. Material and Methods: A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients' details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Results: Total 305 patients were enrolled over a period of one year. In 237 (77.70%) patients antimicrobials prescribed by generic name. In preoperatively and intraoperatively, all the patients received parenteral antimicrobial. Postoperatively, 294 (96.40%) patients received only parenteral antimicrobials while in 11 (3.60%) patients received parenteral antimicrobials followed by oral antimicrobials. Preoperatively antimicrobials started 12 hours prior to surgery. Average duration of antimicrobials given postoperatively was 5.05 ± 1.14 days. Third generation Cephalosporins and Aminoglycosides were prescribed most frequently. Average number of antimicrobials used per patient was 4.40 ± 1.05. In follow up 37 (13.03%) patients developed SSI and most common isolated organism was Staphylococcus aureus. Conclusion: Surgical chemoprophylaxis was inappropriate in terms of choice of antimicrobial agent, timing of administration as well as the total duration of prescription, in majority of the cases, leading to higher SSI. Interventions are warranted to promote the development, dissemination and adoption of evidence based guidelines for antimicrobial prophylaxis.

Assessment of surgical antimicrobial prophylaxis in Orthopaedics and Traumatology Surgical Unit of a Tertiary Care Teaching Hospital in Addis Ababa

“…Other studies also pointed out that prolonged postoperative antimicrobial prophylaxis doesn’t provide any supplementary benefit and indicated that drug resistant pathogens were noted in prolonged prophylaxis [ 2 , 31 ]. In the face of this, 180 (96%) patients received postoperative antimicrobial prophylaxis for more than 24 h after surgery in the Orthopaedics and Traumatology Surgical Unit, akin to numerous studies which reported prolonged postoperative antimicrobial administration [ 1 , 8 , 10 , 31 , 32 ] and study in Gonder University Hospital where duration of surgical prophylaxis was 3–5 days [ 20 ].…”

“…Antimicrobials are valued 20–30% of hospital pharmacy budget [ 7 ] and nearly 30–50% of these antimicrobials are given for SAP [ 5 ]. Yet, 30–90% of these SAPs are inappropriate; most antimicrobials are either given at the wrong time, wrong dosage and wrong strength which results in increased antibiotic usage, increased costs, prolonged hospitalization, super infection, and antimicrobial resistance [ 5 , 8 , 9 ]. Moreover, SAP protocols should be revised, as cost of antimicrobials and resistance change [ 10 ].…”

An Overview of Pre-Operative and Post-Operative Antibiotic Use in Inpatients in Orthopedic Surgery at Dr. H. Moch. Ansari Saleh Banjarmasin

“…Cefadroxil is given in a single dose of 1 g per day or divided doses of 2 x 500 mg. Meanwhile, for children, the dose is 30 mg/kg in a single or 2 divided doses and is usually used for five days of treatment (Sharon, 2007;Mistry, 2013). (Sharon, 2007), (Mistry, 2013) Cefixime was the second choice of antibiotic for oral use after surgery in this study (table 4).…”

“…Meanwhile, for children, the dose is 30 mg/kg in a single or 2 divided doses and is usually used for five days of treatment (Sharon, 2007;Mistry, 2013). (Sharon, 2007), (Mistry, 2013) Cefixime was the second choice of antibiotic for oral use after surgery in this study (table 4). Cefixime is a third-generation cephalosporin belonging to the beta-lactamase group, effectively killing a spectrum of bacteria with the most extended half-life.…”

A Prospective Study of the Impact of Microbiological Cultures on Antibiotic Prescribing Pattern in a Tertiary Care Hospital

“…Sensitivity resistance pattern of the microorganism at a local level of the hospital can be formed for the rational use of the antibiotics and to prevent the development of resistance. The development of effective control programs through the adoption of measures that restrict the use of specific antimicrobials, the establishment of therapeutic guidelines, the constant monitoring of the resistance pattern of the common pathogenic organisms in the hospital are recommended to improve the usage of antibiotics [16].…”