Adherence to American Society of Health-System Pharmacists Surgical Antibiotic Prophylaxis Guideline in Medical City Teaching Hospitals/Baghdad

Nagham T Salih,Dheyaa J Kadhim

doi:10.31351/vol25iss2pp40-45

Abstract

Surgical site infections are the second most common type of adverse events occurring in hospitalized patients. Surgical antibiotic prophylaxis refers to the use of preoperative and postoperative antibiotics to decrease the incidence of postoperative wound infections. The objective of this study was to evaluate the antibiotic administration pattern for surgical antibiotic prophylaxis and the adherence to American Society of Health-System Pharmacists surgical antibiotic prophylaxis guideline in Medical City Teaching Hospitals/Baghdad. The medical records of one hundred patients who underwent elective surgical procedures were reviewed. Adherence to the recommendations of American society of healthâ€‘system pharmacists guideline was assessed for every aspect of antibiotic prophylaxis. The results of this study showed that antibiotic(s) had been administered to all of the patients involved in the study despite the fact that 34 patients (34%) were not required such prophylaxis. While in case of administration time, 13 patients (13%) had received the antibiotic(s) at correct time while 87 patients (87%) at incorrect time. Proper antibiotic(s) selection was found in 11 patients (11.0%) only. All of the patients (100.0%) had received more than 2 doses, and all of them were not in concordance with surgical site infection prevention guidelines. In addition, 19 patients (19.0%) with surgical site infections were identified during hospital stay or within 30 days after surgery. According to these results, we can conclude that there was a substantial gap between surgical antibiotic prophylaxis guideline and their implementation in daily practice in Medical City Teaching Hospitals/Baghdad. Keywords: Surgical Antibiotic Prophylaxis Guidelines, American Society of Health System Pharmacists guidelines, Medical City Teaching Hospitals/Baghdad.

Highlights

Surgical site infections (SSIs) are the commonest hospital-acquired infections in surgical patients (1) and are the second most common cause of nosocomial infections (2).They result in increased antibiotic usage, increased costs and prolonged hospitalization (1)
Surgical antibiotic prophylaxis may be defined as the appropriate use of preoperative and postoperative antibiotics to decrease the incidence of postoperative wound infections (3)
According to this guideline: 1-Cefazolin is regarded the antimicrobial of choice for most surgical procedures. 2-The optimum administration's time for of prophylactic antibiotics dose is within 60 minutes before the surgical incision. 3Single-dose prophylaxis is usually sufficient with duration of less than 24 hours for all procedures. 4-Antimicrobial prophylaxis may be beneficial in surgical procedures associated with a high rate of infection and in certain clean procedures where there are severe consequences of infection, even if Infection is unlikely (5)

Summary

Introduction

Surgical site infections (SSIs) are the commonest hospital-acquired infections in surgical patients (1) and are the second most common cause of nosocomial infections (2).They result in increased antibiotic usage, increased costs and prolonged hospitalization (1). Surgical antibiotic prophylaxis may be defined as the appropriate use of preoperative and postoperative antibiotics to decrease the incidence of postoperative wound infections (3). Dirty operations take place in situations of existing infection and antimicrobials are used for treatment, not prophylaxis (4). 4-Antimicrobial prophylaxis may be beneficial in surgical procedures associated with a high rate of infection (i.e., clean-contaminated or contaminated procedures) and in certain clean procedures where there are severe consequences of infection (e.g., prosthetic implants), even if Infection is unlikely (5). Antibiotic administration continued beyond 24 hours has not been shown to be superior to shorter duration antibiotic prophylaxis in most surgical procedures. Singledose antibiotic prophylaxis provides the optimal balance for reducing wound infections in most operative procedures and decreasing adverse drug effects (3)

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