Dataset Information

Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital.

ABSTRACT:

Background

Surgical antimicrobial prophylaxis guidelines are considered as important interventional tools for antimicrobial resistance. Guideline compliance was poor across different countries and thus results in an inappropriate and overuse of antibiotics.

Objective

To evaluate the selection, timing and duration of prophylactic antibiotic administration among surgical patients in Nekmte referral hospital.

Method

Prospective, facility based cross-sectional study was conducted from 1st April to 30th June 2017. Data were collected using data abstraction format among surgical inpatients prescribed with surgical antibiotic prophylaxis. Surgical antimicrobial prophylaxis guidelines were used as data assessment protocols. SPSS version 21.0 was used for data entry and analysis. Descriptive statistics and binary logistic regression were used for analysis.

Results

The median age of the study participants was 35.0 (IQR: 25-50) years with the preponderance (58.8%) of male patients. The median hospitalization period was 8.0 (IQR: 5-11) days. Majority of the participants were from the general surgical ward (60.1%). About 43% of the procedures were clean. Most of the surgical cases were gastrointestinal (39.2%). Only 10.6% of the drug selections comply with American Society of Health-System Pharmacists guideline. Surprisingly, none of the selections were compliant to the national Standard Treatment Guideline of the country. About 84% of the study participants received ceftriaxone. Majority of the prophylactic antibiotics (75.8%) were administered for greater than 24 hours and above half (52.3%) of the antibiotics were administered preoperatively. Emergent surgery procedures (AOR = 2.89, 95% CI: (1.09-9.10) and being a male patient (AOR = 3.10, 95% CI: 1.07-8.98) were associated with inappropriate preoperative antibiotic administration. Patients admitted to the gynecology and obstetrics ward was less likely to receive surgical prophylaxis for greater than 24 hours (AOR = 0.07, 95% CI: 0.01-0.81).

Conclusion

Surgical antibiotic compliance was far below the guideline recommendation. Patients admitted in the gynecology and obstetrics ward were more likely to comply with the surgical antimicrobial prophylaxis duration recommendation. The timing was most likely to be inappropriate among male patients and patients on emergent surgery. Availability and awareness creation on the antibiotic drugs and the guidelines were important interventions recommended for appropriate surgical antimicrobial use.

SUBMITTER: Alemkere G

PROVIDER: S-EPMC6136737 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital.

Alemkere Getachew G

PloS one 20180913 9

<h4>Background</h4>Surgical antimicrobial prophylaxis guidelines are considered as important interventional tools for antimicrobial resistance. Guideline compliance was poor across different countries and thus results in an inappropriate and overuse of antibiotics.<h4>Objective</h4>To evaluate the selection, timing and duration of prophylactic antibiotic administration among surgical patients in Nekmte referral hospital.<h4>Method</h4>Prospective, facility based cross-sectional study was conduct ...[more]

PMID: 30212477

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Project description:An audit of the antibiotic prophylaxis in surgical procedures is the basic area of antimicrobial stewardship programme. The current research aimed to evaluate the adherence-proportion of the pre-operative antibiotic prophylaxis (PAP) practices in common elective surgical procedures. It was an eight-month (January 2017 to August 2017) observational cross-sectional patients' treatment record-based study conducted at two tertiary care teaching hospitals of Islamabad, Pakistan. We investigated the three most commonly performed elective general surgical procedures at the hospitals in adults aged > 18 years with no previous infection or surgery. The required data were extracted from the medical charts. Current prescribing practices were compared with the standard prescribing guidelines. A total of 660 (Government Hospital (GH), n = 330 and Private Hospital (PH), n = 330) procedures were observed. The most commonly performed elective general surgical procedures were laparoscopic cholecystectomy 307/660 (46.5%), followed by direct inguinal hernia 197/660 (29.8%) and total thyroidectomy 156/660 (23.6%). Non-use of PAP was observed in 64/660 (9.7%) cases. PAP was given to 90.3% (n = 596/660) cases (300/330 (90.9%) patients in GH and 296/330 (89.7%) in PH; P = 0.599). Based on the existing guidelines, the choice of antibiotics was correct in only 4.2% (25/596) patients (10/300; 3.3% cases at GH and 15/296; 5% at PH). The appropriate use of antibiotics was significantly greater in direct inguinal hernia (n = 19/193; 9.8%) cases compared with that in total thyroidectomy (n = 4/152; 2.6%) and laparoscopic cholecystectomy (n = 2/251; 0.8%) cases; P = 0.001. Compliance to the timing was only 51% (n = 304/596) of the total patients received PAP which was significantly lower in GH 97/300 (32.3%) as compared with that in PH 207/296 (69.9%); P = 0.001. Administration timing of antibiotics was observed to be more appropriate in total thyroidectomy (n = 79/152; 51.9%) cases than in laparoscopic cholecystectomy (n = 130/251; 51.8%) and direct inguinal hernia (n = 95/193; 49.2%) cases; P = 0.001. The route and dose were appropriate in accordance with the guidelines in all cases (100%). Most of the patients received ceftriaxone, a third-generation cephalosporin that is no longer recommended by the latest international guidelines. The current analysis revealed an alarmingly poor adherence rate with the guidelines in the three elective surgical procedures at both hospitals. To improve the situation, training and awareness programs about the antimicrobial stewardship interventions on the institutional level may be valuable.

Project description:BackgroundSurgical antibiotic prophylaxis (SAP) is one of the most effective measures to prevent surgical site infections (SSIs). According to WHO SAP guidelines, SAP requires appropriate indication for administration and delivery of the antimicrobial agent to the operative site through intravenous administration within 60-120 min before the initial surgical incision is made. In Liberia, it is unknown how surgeons practice and there has been anecdotal observation of antibiotic overuse.ObjectiveTo elucidate baseline SAP compliance, particularly appropriate SAP use based on wound class and time of antibiotic administration.MethodsAn observational, cross-sectional study was conducted from November to December 2017. One-day training was provided on SAP/SSI to 24 health workers by the Ministry of Health and WHO. Following this training, surgical cases (general surgery and obstetrics and gynaecology (OB/GYN) underwent chart review with focus on time of SAP administration and appropriate SAP based on Centers for Disease Control and Prevention (CDC) wound classification.ResultsA total of 143 charts were reviewed. Twenty-nine (20.3%) cases showed appropriate prophylaxis through administrations of antibiotics 120 min before surgical incision, resulting in SAP compliance. One hundred and fourteen cases (79.7%) showed SAP noncompliance with timing of antibiotic administration. Of the OB/Gyn cases, 109 wounds were classified as Class I (clean) and one wound was classified as Class III (contaminated). For General Surgical cases, 32 wounds were classified as Class I and one as Class III. Of the 109 Class I OB/Gyn surgeries, 24 (22%) were appropriately given antibiotics based on the CDC wound guidelines while 78% were non-compliant with recommendations. Of the 32 Class I General surgery cases, 4 (12.5%) were compliant with antibiotics guidelines while 28 (87.5%) were not.ConclusionCompliance with SAP is low. More studies need to be done to explore the contributing factors to this. Implementing mechanisms to achieve proper use of SAP is needed.

Project description:BackgroundSurgical Site Infections are a major cause of morbidity and mortality among operated patients. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medication for a single patient. Few studies have shown qualitatively factors influencing this and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania.ObjectiveTo describe the perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital.MethodsA qualitative study involving in-depth interviews with surgeons was conducted in English by the primary investigator. The interviews were audio-recorded and transcribed verbatim. Systematic text condensation by Malterud was used for data analysis.FindingsFourteen surgeons and obstetrics and gynaecologists participated. Their perceptions were summarized into three main categories: Inadequate data to support practice; one who sees the patient decides the antibiotic prophylaxis; prolonged antibiotic use for fear of unknown. The participants perceived that choice of antibiotic should be based on local hospital data for bacterial resistance pattern, however the hospital guidelines and data for surgical site infection rates are unknown. Fear of getting infection and anticipating complications led to prolonged antibiotics use.ConclusionThe study provides an understanding of surgical antibiotic prophylaxis use and its implementation challenges. This was partly expressed by unavailability of local data and guidelines to enhance practice. To improve this, there is a need of guidelines that incorporates local resistance surveillance data and enhanced antibiotic stewardship programmes. A strong consideration should be placed into ways to combat the fears of surgeons for complications, as these significantly affect the current practise with use of surgical antibiotic prophylaxis.

Dataset Information

Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital.

Background

Objective

Method

Results

Conclusion

Publications

Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital.

Similar Datasets

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