Assessment of perioperative antibiotic prophylaxis for gynecological surgeries at an academic hospital in Brazil

Denise Ramos Dos Santos,Milene Rangel Da Costa

doi:10.33448/rsd-v10i8.17299

Abstract

The aim of this study was to assess the adequacy of physicians' practice patterns regarding the use of perioperative antibiotic prophylaxis for gynecological surgeries in an academic hospital specialized in gynecology located at Rio de Janeiro city, Brazil. This is a retrospective study assessing all gynecological surgeries performed over one year. Appropriateness of antibiotic prophylaxis was determined according to criteria adapted from evidence-based guidelines. Clinical practice regarding the use of perioperative antibiotic prophylaxis was considered appropriate for 58.4% of 416 surgeries. The non-indicated use of antimicrobial prophylaxis was the main factor determining the low percentage of overall adequacy. Three variables were independently associated with inappropriate administration of perioperative antibiotics: patients age, breast surgeries and longer procedures. Antibiotic prophylaxis compliance to published recommendations is low. Women undergoing gynecological surgery are exposed to unnecessary risks associated to non-indicated use of antibiotic prophylaxis. Strategies aimed to improve compliance to evidence-based guidelines are necessary.

Highlights

Surgical site infections (SSI) are the most frequent surgical complication in developing countries and affect as many as 11% of patients undergoing surgical procedures (Allegranzi et al, 2011)
The objective of this study was to assess physicians' practice patterns regarding the use of perioperative antimicrobial prophylaxis (PAP) in the light of evidence-based guidelines at a university hospital in Brazil
PAP appropriateness was assessed according to criteria adapted from the recommendations of the American Society of Health-system Pharmacists (ASHP) (Bratzler et al, 2013) American College of Obstetricians and Gynecologists (ACOG, 2018), American Society of Breast Surgeons (ASBrS, 2020) and the Brazilian Health Regulatory Agency (ANVISA, 2017)

Summary

Introduction

Surgical site infections (SSI) are the most frequent surgical complication in developing countries and affect as many as 11% of patients undergoing surgical procedures (Allegranzi et al, 2011). In Brazil, they account for 14% to 16% of all nosocomial infections (ANVISA, 2009), with the highest incidence being among obstetric or gynecological patients (Clifford & Daley, 2012; Jaiyeoba, 2012). Most of SSI are preventable if perioperative antimicrobial prophylaxis (PAP) is available (Allegranzi et al, 2011). Different national and local clinical practice guidelines recommend PAP as the standard of care for different types of obstetric and gynecological procedures (ACOG, 2018; ANVISA, 2017; ASBrS, 2018; Bratzler et al, 2013; van Eyk, 2010; van Eyk, 2012; Leaper et al, 2008; Morrill et al, 2013)

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