Indian Survey of Surgical Antibiotic Prophylaxis (ISSAP 2017)

Abstract

Background: Surgical site infections(SSIs) are one of the most common healthcare-associated infections. Patients developing SSIs are 60% more likely to be admitted to an ICU, and are > 5 times likely to be re-admitted to hospital. Using Antibiotic prophylaxis(AP) decreases SSIs, but the usual long courses of AP can lead to increasing antimicrobial-resistance, super-infection with resistant pathogens, and unnecessary costs. WHO has constantly addressed the issues related to surgical antimicrobial prophylaxis(SAP) but there is less of Indian data. This survey helps us understand the current trends in SAP in common surgical practice of Indian-surgeons. Methods & Materials: This was a real-world, questionnaire-based survey involving 126 surgeons from India. Of these, 94(74.6%) surgeons duly filled in the questionnaire. The analysis was based on the data from these 94 surgeons and performed using SPSS version 22.0. Results: In 95.74% of cases, SAP was selected based upon the classification of surgical wounds. The risk of SSIs was higher in case of dirty-surgeries(70.21%) compared to contaminated-(58.5%) and clean-contaminated(12.77%). Out of 94, 36.17% preferred cefazolin as the first-line SAP for prevention of deep wound infections followed by cefuroxime(32%), ceftriaxone(28.72%), and co-amoxiclav(15.96%). For pre-operative prophylaxis, 42.5% of surgeons preferred giving one dose within 1 hour prior to incision and 29% of surgeons gave it 30-minutes prior to incision. Intra-operatively, 38% of surgeons re-dosed the antibiotic every 4 hours due to following reasons: half-life/duration of surgery(59.57%), wound size/procedure/case complexity(21.28%), estimated blood loss/IV fluid dilution-(15.96%), literature reference(4.26%). A few cases continued SAP post-operatively because: operation theatre (OT) doesn’t meet the required standards(23.4%), consultant surgeon's preference(22.34%), prevention of SSIs(20.21%), lack of OT discipline(19.15%), and unreliable sterility of instruments(18.09%). In the high (>10%) extended-spectrum beta-lactamases (ESBL)-prevalent areas, 95.74% of surgeons opined that SAP should be modified to either piperacillin-tazobactam(44.4%) or cefoperazone-sulbactam(26.67%) depending upon susceptibility. However, 16% of surgeons used the combination of amikacin-metronidazole. Conclusion: Surgeon in India are largely following the published SAP guidelines. However well-designed, randomised trials are needed to address concerns like post-operative continuation and choice of the SAP in ESBLs prevalent areas.