Appropriateness of Surgical Antimicrobial Prophylaxis in a tertiary care hospital: A prospective observational study

Shailaja K (1) , Fragrance Jemimah D (2) , Aritta Hillari L S (3) , Priyanka N (4)
(1) Asso. Professor, C L Baid Metha College of Pharmacy, Affiliated to The Tamil Nadu Dr. MGR Medical University, Thoraipakkam, Chennai – 97 India, India ,
(2) Pharm.D, C L Baid Metha College of Pharmacy, Affiliated to The Tamil Nadu Dr. MGR Medical University, Thoraipakkam, Chennai – 97 India, India ,
(3) Pharm.D, C L Baid Metha College of Pharmacy, Affiliated to The Tamil Nadu Dr. MGR Medical University, Thoraipakkam, Chennai – 97 India, India ,
(4) Pharm.D, C L Baid Metha College of Pharmacy, Affiliated to The Tamil Nadu Dr. MGR Medical University, Thoraipakkam, Chennai – 97 India, India

Abstract

Surgical site infections (SSIs) are a significant concern in global healthcare, particularly in middle and low-income countries, leading to increased hospitalizations, morbidity, mortality, and financial strain. Ranked third in the CDC's National Nosocomial Infections Surveillance System, SSIs have prompted a focus on preventive measures, notably surgical antimicrobial prophylaxis (SAP). However, SAP is often used inappropriately, contributing to the rise of Antimicrobial Resistance (AMR). Addressing this, a six-month prospective observational study was conducted in a tertiary care hospital to assess the adherence to SAP guidelines among 386 patients undergoing surgeries in various specialties. The study aimed to evaluate the appropriateness of SAP practices and identify factors leading to non-compliance. Results showed that only 58.3% of patients fully adhered to the guidelines. While 100% compliance was observed in SAP indication, lower adherence was noted in the timing of administration (97.7%), choice of SAP (85%), and duration of prophylaxis (70.2%). These findings underscore a significant gap between recommended SAP practices and actual implementation. This gap highlights the need for stronger Institutional Antimicrobial Stewardship (AMS) programs and the critical role of clinical pharmacists in regularly evaluating SAP and prescribing practices. To combat the rise of antibiotic resistance while ensuring patient safety, enhancing SAP practices in line with national and international recommendations is essential. The study advocates for more active interventions at the time of order to optimize antibiotic use, thereby addressing the challenge of compliance in SAP guidelines.

Full text article

Generated from XML file

References

John Hopkins Medicine. (2019). Surgical Site Infections. [Online]. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections [Accessed: 2 November 2023].

Ahmed, NJ., Almalki, ZS., Alfaifi, AA., Alshehri, AM., Alahmari, AK., Elazab, E., Almansour, A., Haseeb, A., Balaha, MF., and Khan, AH. (2022). Implementing an Antimicrobial Stewardship Programme to Improve Adherence to a Perioperative Prophylaxis Guideline. Healthcare (Basel), 10(3):464.

Agency for Healthcare Research and Quality. (7 September 2019). Surgical Site Infections. [Online]. PSNet. Ahrq.gov. Available at: https://psnet.ahrq.gov/primer/surgical-site-infections [Accessed: 3 November 2023].

CDC. (2019). Surgical Site Infection (SSI). Centers for Disease Control and Prevention. https://www.cdc.gov/hai/ssi/ssi.html [Accessed: 3 November 2023].

Mengistu, DA., Alemu, A., Abdukadir, AA., Mohammed, HA., Ahmed, F., Mohammed, B., and Musa, I. (2023). Global Incidence of Surgical Site Infection Among Patients: Systematic Review and Meta-Analysis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 60:004695802311625.

Geneva: World Health Organization. (2018). Global Guidelines for the Prevention of Surgical Site Infection. [Online]. NCBI. Available at: https://www.ncbi.nlm.nih.gov/books/NBK536404/ [Accessed: 3 November 2023].

Marano, L., Carbone, L., Poto, GE., Calomino, N., Neri, A., Piagnerelli, R., Fontani, A., Verr. (2022). Antimicrobial Prophylaxis Reduces the Rate of Surgical Site Infection in Upper Gastrointestinal Surgery: A Systematic Re. Antibiotics (Basel). 11(2):230.

Bratzler, DW., Dellinger, EP., Olsen, KM., Perl, TM., Auwaerter, PG., Bolon, MK., Fish, DN., Napolitano, LM., Sawyer, RG., Slain, D., Steinberg, JP., and Weinstein, RA. (2013). Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. Feb 1; 70(3):195-283.

Vippadapu, P., Gillani, SW., Thomas, D., Ahmed, F., Gulam, SM., Mahmood, RK., Menon, V., Abdi, S., and Rathore, HA. (2022). Choice of Antimicrobials in Surgical Prophylaxis - Overuse and Surgical Site Infection Outcomes from a Tertiary-Level Care Hospital. Front. Pharmacol. 13:849044.

Cefuroxime; eEML - Electronic Essential Medicines List. [Online] list.essentialmeds.org. Available at: https://list.essentialmeds.org/recommendations/857 [Accessed: 2 Nov 2023].

World health statistics. (2022). Monitoring health for the SDGs, sustainable development goals. [Online] Available at: https://www.who.int/publications/i/item/9789240051157 [Accessed: 3 Nov 2023].

WHO. (2019). New report calls for urgent action to avert antimicrobial resistance crisis. [Online] www.who.int. Available at: https://www.who.int/news/item/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis [Accessed: 3 Nov 2023].

Menz, BD., Charani, E., Gordon, DL., Leather, AJM., Moonesinghe, SR., and Phillips, CJ. (2021). Surgical Antibiotic Prophylaxis in an Era of Antibiotic Resistance: Common Resistant Bacteria and Wider Considerations for Practice. Infect Drug Resist. Dec 7;14:5235-5252.

WHO. (2019). WHO releases the 2019 AWaRe Classification Antibiotics. [Online] www.who.int. Available at: https://www.who.int/news/item/01-10-2019-who-releases-the-2019-aware-classification-antibiotics [Accessed: 3 Nov 2023].

New AWaRe tool aims to guide antibiotic use globally. (2019). CIDRAP. [Online] www.cidrap.umn.edu. Available at: https://www.cidrap.umn.edu/news-perspective/2019/06/new-aware-tool-aims-guide-antibiotic-use-globally [Accessed 2 Nov 2023].

‎Aware classification‎. World Health Organization, [Online] Available at: https://www.who.int/publications/i/item/2021-aware-classification [Accessed: 3 Nov 2023].

Gurunthalingam, M P., Keche, YN., Gaikwad, NR., Dhaneria, S., and Singh, MP. (2023). Appropriateness of Surgical Antibiotic Prophylaxis in a Tertiary Care Teaching Hospital in Central India: A Retrospective Analysis. Cureus. May 10;15(5): e38844.

WHO guidelines for safe surgery 2009: Safe surgery saves lives. [Online] World Health Organization. 1970. Available at: https://apps.who.int/iris/handle/10665/44185 [Accessed: 4 Nov 2023].

Sefah, IA., Denoo, EY., Bangalee, V., Kurdi, A., Sneddon, J., Godman, B. (2022). Appropriateness of surgical antimicrobial prophylaxis in a teaching hospital in Ghana: findings and implications, JAC-Antimicrobial Resistance. 4(5).

Thabit, AK., Fairaq, EM., and Almutairi, FS. (2023). Appropriateness of choice and duration of surgical antibiotic prophylaxis and the incidence of surgical site infections: A prospective study. Journal of Taibah University Medical Sciences. 18:26–31.

Piri A, Taher A, Rahimi-Bashar F, Mohammadi Y, Mehrpooya M. (2022). Assessment of antibiotic prophylaxis in surgical patients at a referral teaching hospital in Western Iran. Avicenna J Pharm Res. 3(1):8-16.

Khan, Z., Ahmed, N., Rehman, A., Khan, FU., Saqlain, M., Martins, MAP., and Rahman, H. (2020). Audit of pre-operative antibiotic prophylaxis usage in elective surgical procedures in two teaching hospitals, Islamabad, Pakistan: An observational cross-sectional study. PLoS ONE.15(4).

Sathoo, S., Thomas, V., Kannan, A., Bajaj, D., & Abu Srinivasan, A. (2021). Optimal timing of antimicrobial prophylaxis before surgery: a review of recent evidence. EXCLI Journal, 20, 1621–1623.

ACOG Practice Bulletin No. 199: Use of Prophylactic Antibiotics in Labor and Delivery. Obstetrics & Gynecology 132(3):e103-e119, September 2018.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. (1999). Guideline for Prevention of Surgical Site Infection. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 27(2):97-132.

Dale, WB., Peter, MH. (2004). Antimicrobial Prophylaxis for Surgery: An Advisory Statement from the National Surgical Infection Prevention Project. Clinical Infectious Diseases. 38:1706–15.

Segala, FV., Murri, R., Taddei, E., Giovannenze, F., Vecchio, PD., Birocchi, E., Taccari, F., Cauda, R., and Fantoni, M. (2020). Antibiotic appropriateness and adherence to local guidelines in perioperative prophylaxis: Results from an antimicrobial stewardship intervention. Antimicrob Resist Infect Control 9:164.

Ierano, C., Thursky, K., Marshall, C., Koninget, S., James, R., Johnson, S., Imam, N., Worth, LJ., and Peel, T. (2019). Appropriateness of surgical antimicrobial prophylaxis practices in Australia. JAMA Network Open 2.

Schonberger, RB., Barash, PG., Lagasse, RS. (2015). The Surgical Care Improvement Project Antibiotic Guidelines: Should We Expect More Than Good Intentions? Anesthesia & Analgesia. 121(2):397-403.

Munckhof, W. (2005). Antibiotics for surgical prophylaxis. Australian Prescriber. 28:38-40.

Authors

Shailaja K
Fragrance Jemimah D
fragrancejemimah@gmail.com (Primary Contact)
Aritta Hillari L S
Priyanka N
K, S., D, F. J., L S, A. H., & N, P. (2023). Appropriateness of Surgical Antimicrobial Prophylaxis in a tertiary care hospital: A prospective observational study. International Journal of Research in Pharmaceutical Sciences, 14(4), 200–208. https://doi.org/10.26452/ijrps.v14i4.4549

Article Details

Similar Articles

You may also start an advanced similarity search for this article.

No Related Submission Found