Abstract
Surgical site infection (SSI) constitutes a major problem in healthcare in terms of healthcare cost, morbidity and mortality. Surgical antibiotic prophylaxis (SAP) is one of the effective strategies for SSI prevention. Poor adherence to SAP guidelines across different countries has been observed. Misuse of prophylactic antibiotics threatens patient safety and leads to an increase in the acquisition of antibiotic resistance. The aim of this study was to assess the utilization of SAP in obstetric and gynecologic procedures in terms of indication for prophylaxis, antibiotic selection, timing of administration and prophylaxis duration. A prospective observational study was conducted at the obstetrics and gynecology department of Zagazig University Hospital during the period from January 2020 to June 2020. Medical records of 264 women were recorded and evaluated. The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines, World Health Organization (WHO) recommendations and The American College of Obstetricians and Gynecologists (ACOG) practice bulletin were used for data evaluation and hence women were stratified into two groups. For women who underwent procedures in which guidelines recommended the use of SAP (200 patients; 75.75%), 198 women (99%) received preoperative prophylaxis. None of women (0%) received the recommended first line antibiotic by guidelines while the most commonly used prophylactic antibiotics were Cefotaxime (86 patients; 43.43%) and Ampicillin-sulbactam (62 patients; 31.31%). Preoperative antibiotic prophylaxis timing was 0-60 minutes before skin incision. All women received postoperative prophylaxis that extended to an average of 7 days. Regarding the other group who underwent procedures in which prophylactic antibiotics weren’t recommended by guidelines (64 patients; 24.24%), 37 women (57.81%) followed the guidelines and didn’t receive SAP while 27 women (42.18%) received SAP. Poor adherence to guidelines recommendations regarding prophylactic antibiotic selection and prophylaxis duration was observed. High utilization rate of prophylactic antibiotics in procedures that didn’t require their use was reported..
Highlights
Surgical antibiotic prophylaxis (SAP) is the rational, effective and safe use of antibiotic agents for reducing the risk of surgical site infection (SSI) (Bratzler et al 2013)
The selection of prophylactic antibiotics and the duration of prophylaxis were inconsistent with the recommendations of American Society of Health-System Pharmacists (ASHP), World Health Organization (WHO) and ACOG guidelines
The use of broad spectrum prophylactic antibiotics and multidrug regimen were common practices identified in this study
Summary
Surgical antibiotic prophylaxis (SAP) is the rational, effective and safe use of antibiotic agents for reducing the risk of surgical site infection (SSI) (Bratzler et al 2013). Guidelines showed that appropriate SAP is one of the effective strategies for SSI prevention (Bratzler et al 2013, WHO 2019). For optimal outcomes; SAP should be used when indicated, the selected prophylactic antibiotics should cover the likely pathogens on the operative site and the choice of antibiotic should consider the local pattern of antibiotic resistance (SIGN 2014). Poor adherence to SAP guidelines constitutes a significant problem, in: antibiotic selection, timing of prophylaxis administration and duration of prophylaxis (Ng and Chong 2012). WHO reported that misuse of SAP threatens patients safety and leads to an increase in the acquisition and spread of antibiotic resistance (WHO 2019)
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