Appropriateness of antimicrobial prophylaxis practices according to the guidelines in two common gynaecological surgeries

Abstract

Background: Most postsurgical infections can be prevented through the effective use of antimicrobial. This study was conducted to investigate the antimicrobial prophylaxis practices and adherence to guidelines in gynecological surgeries. Methods: An audit based prospective study was carried out between February and April 2019 in the gynecological ward in a teaching hospital, Peshawar, Pakistan. This study included women who had two common surgical procedures (caesarean surgery and hysterectomy), did not undergo any previous surgery and having no infection at the time of surgery. The indication, choice/selection, timing and pattern of antimicrobials were the main evaluated parameters. The required information was collected from medical records through standardized data collection proforma. Observed prescribing practices were compared with antimicrobial prophylaxis guideline. Results: A total of 264 patients (caesarean surgery n = 173 and hysterectomy n = 91) with mean age: 32.6 ± 6.3 years were recruited in the analysis. Antimicrobial was prescribed to 241 patients (91.3%). The selection and timing of antimicrobial were adhered to guidelines in 40.7% and 56.4% cases, respectively (optimal value 100%). There was a statistically significant difference between guideline recommendations and antimicrobial practice in surgical procedures (P = 0.000).The commonly prescribed antimicrobials were ceftriaxone (22.4%) and cefazolin (22%).The combination usage of antimicrobial was also observed. Conclusion: Inappropriate use of antimicrobial prophylaxis and low adherence to standard guidelines was observed. Periodic audit and awareness about standard guidelines are required for the judicial use of antimicrobials in surgery.