Pattern of Surgical Antibiotic Prophylaxis for Surgical Site Infections in at two Teaching Hospitals, Islamabad, Pakistan

Year 2019, , 104 - 111, 15.09.2019

Zakir Khan Naveed Ahmed Asim-ur- Rehman Faiz Ullah Khan Hazir Rahman

https://doi.org/10.5799/jmid.614180

Cited By: 4

Abstract

Objectives: To investigate the utilization pattern of Surgical
antibiotic prophylaxis (SAP) for the prevention of surgical infections in most
common abdominal and orthopedic surgical procedures.

Methods:
A prospective observational and non-intervention study was conducted at two
teaching hospitals (PIMS and SIH) in Islamabad, Pakistan. Prescriptions records
were reviewed to assess the utilization pattern of SAP during the nine-month duration.
Data regarding most common surgical procedures, antimicrobial utilization,
dose, route and administration timing of SAP were extracted for analysis.
Observed practices were compared with standard treatment guidelines.

Results:
Out of total 1512 surgical procedures about, 56.9% (n=860) of patients
performed abdominal followed by 652 (43.1%) orthopedic surgical procedures. A
total of 212 (14%) surgical procedures were completely correct in all steps.
SAP were given in 1474 (97.5%) of surgical procedures. In 712 of the
participants (48.3%) were given Ceftriaxone following by Cefazolin (n=247,
16.7%). Abdominal surgeries were majorly managed with Ceftriaxone (59%) while
the orthopedic surgeries managed with Ceftriaxone (31.3%) and Cefazolin (30%).
Appropriate choice of SAP was observed in (n=275; 18.6%) procedures and about
half (n=719, 49%) received antibiotics within optimal timing. The appropriate
choice/selection of SAP according to the guidelines was greater in orthopedic
surgical procedures (n=212; 14.8%) than abdominal surgeries (n=63; 4.3%); p≤0.001.
Compliance with respect to timing was significantly lower in an orthopedic
surgical procedure (n=301) as compared to abdominal surgeries (n=418); p≤0.001.
Similarly, a statistically significant difference observed between PIMS and SIH
with respect to SAP practices; p≤0.001.

Conclusions: Inappropriate choice, the timing of administration
and combination of SAP were observed in the current study. J Microbiol Infect Dis 2019; 9(3):104-111.

Keywords

Surgery, perioperative, antibiotic, prophylaxis, hospital

References

• 1. Alemkere G. Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte Referral Hospital. PloS one 2018; 13(9):e0203523. 2. Ayele Y, Taye H. Antibiotic utilization pattern for surgical site infection prophylaxis at Dil Chora Referral Hospital Surgical Ward, Dire Dawa, Eastern Ethiopia. BMC Res Notes 2018; 11(1):537. 3. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am College of Surgeons 2017; 224(1):59-74. 4. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surgical infections, 2013. 14(1): p. 73-156. 5. Hosoglu S, Aslan S, Akalin S, Bosnak V. Audit of quality of perioperative antimicrobial prophylaxis. Pharmacy World & Science 2009: 31(1):14-17. 6. Nabovati E, Vakili-Arki H, Taherzadeh Z, Hasibian MR, Abu-Hanna A, Eslami S. Drug-drug interactions in inpatient and outpatient settings in Iran: a systematic review of the literature. DARU J Pharmaceutic Sci 2014: 22(1):52. 7. Butt SZ, Ahmad M, Saeed Hamid, Saleem Z, Javaid Z. Post-surgical antibiotic prophylaxis: Impact of pharmacist’s educational intervention on appropriate use of antibiotics. J Infect Public Health 2019. https://doi.org/10.1016/j.jiph.2019.05.015. 8. Khan Z, Ahmed N, Rehman AU, Khan FU, Rahman H. Utilization of Antibiotic Prophylaxis in Three Common Abdominal Surgeries, Adherence to Standard Guidelines and Surgeons' Perception in Teaching Hospitals, Islamabad, Pakistan. MDPI preprint 2019: 2019060119. https://www.preprints.org/manuscript/201906.0119/v1. 9. Nausheen S, Hammad R, Khan A. Rational use of antibiotics--a quality improvement initiative in hospital setting. J Pak Med Assoc 2013; 63(1):60. 10. Atif M, Azeem M, Sarwar MR, et al. WHO/INRUD prescribing indicators and prescribing trends of antibiotics in the accident and emergency department of Bahawal Victoria hospital, Pakistan. Springerplus 2016; 5(1):1928. 11. Hansen S, Sohr D, Piening B, et al. Antibiotic usage in German hospitals: results of the second national prevalence study. J Antimicrob Chemother 2013; 68(12):2934-2939. 12. World Health organization ATC/DDD Methodology. 2018. World Health organization (WHO) ATC/DDD Methodology. 2018. Available from< https://www.who.int/medicines/regulation/medicines-safety/toolkit_methodology/en/>. Accessed 12 December 2018. 13. Martin C, Pourriat J. Quality of perioperative antibiotic administration by French anaesthetists. J Hosp Infect 1998; 40(1):47-53. 14. Giordano M, Squillace L, Pavia M. Appropriateness of surgical antibiotic prophylaxis in pediatric patients in Italy. Infect Control Hosp Epidemiol 2017; 38(7):823-831. 15. Schmitt C, Lacerda RA, Padoveze MC, Turrini RN. Applying validated quality indicators to surgical antibiotic prophylaxis in a Brazilian hospital: learning what should be learned. Am J Infect Control 2012; 40(10):960-962. 16. Hohmann C, Eickhoff C, Radziwill R, Schulz M. Adherence to guidelines for antibiotic prophylaxis in surgery patients in German hospitals: a multicentre evaluation involving pharmacy interns. Infection 2012; 40(2):131-137. 17. Hosoglu S, Sunbul M, Erol S, et al, A national survey of surgical antibiotic prophylaxis in Turkey. Infect Control Hosp Epidemiol 2003; 24(10):758-761. 18. Tourmousoglou CE, Yiannakopoulou ECh, Kalapothaki V, Bramis J, Papadopoulos J. Adherence to guidelines for antibiotic prophylaxis in general surgery: a critical appraisal. J Antimicrob Chemother 2007; 61(1):214-218. 19. Parulekar L, Soman R, Singhal T, Rodrigues C, Dastur FD, Mehta A. How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study. Indian J Surg 2009; 71(1):15-18. 20. Abubakar U, Sulaiman SS, Adesiyun A. Utilization of surgical antibiotic prophylaxis for obstetrics and gynaecology surgeries in Northern Nigeria. Int J Clin Pharm 2018; 40(5):1037-1043. 21. Jaber S, Rogers C, Sunderland B, et al. Appropriateness of surgical antibiotic prophylaxis for breast surgery procedures. Int J Clin Pharm 2017; 39(2):483-486. 22. Al-Momany NH, Al-Bakri AG, Makahleh ZM, Wazaify MM. Adherence to international antimicrobial prophylaxis guidelines in cardiac surgery: a Jordanian study demonstrates need for quality improvement. J Manag Care Pharm 2009; 15(3):262-271. 23. Oh AL, Goh LM, Nik Azim NA, Tee CS, Shehab PCW. Antibiotic usage in surgical prophylaxis: a prospective surveillance of surgical wards at a tertiary hospital in Malaysia. J Infect Dev Ctries 2014; 8(02):193-201. 24. Young B, Ng TM, Teng C, Ang B, Tai HY, Lye DC. Non-concordance with Surgical Site Infection Prevention Guidelines and the Rate of Surgical Site Infections for General Surgical, Neurological and Orthopedic Procedures. Antimicrob Agents Chemother 2011; 55(10):4659-63. 25. Napolitano F, Izzo MT, Giuseppe G, Angelillo IF. Evaluation of the appropriate perioperative antibiotic prophylaxis in Italy. PloS one 2013; 8(11):e79532. 26. Shiva F, Ghanaie R, Shirvani FShiva, et al. Pattern of Antibiotic Usage in Children Hospitalized for Common Infectious Diseases. Arch Pediatr Infect Dis 2018. 2018; 6(1):e34474. 27. Saied T, Hafez SF, Kandeel A, et al. Antimicrobial stewardship to optimize the use of antimicrobials for surgical prophylaxis in Egypt: A multicenter pilot intervention study. Am J Infect Control 2015; 43(11):e67-e71. 28. Hawn MT, Itani KM, Gray SH, Vick CC, Henderson W, Houston TK. Association of timely administration of prophylactic antibiotics for major surgical procedures and surgical site infection. J Am Coll Surg 2008; 206(5):814-819. 29. Musmar SM, Baba H. Adherence to guidelines of antibiotic prophylactic use in surgery: a prospective cohort study in North West Bank, Palestine. BMC Surg 2014; 14(1):