Abstract
BackgroundSingle-dose perioperative antibiotic prophylaxis (PAP) is recommended for clean, non-infectious surgeries to prevent surgical site infections. However, the common practice of unindicated use and prolonged use of antibiotics contributes to the development and spread of antibiotic resistance (ABR). The present study explores the perioperative use of antibiotics among inpatients with surgical indications at surgery departments of a teaching (TH) and a non-teaching (NTH) tertiary care hospital in Madhya Pradesh, India.MethodsData was collected manually for all inpatients for 3 years (April 2008–August 2011). Patients with non-infectious surgical indications were selected for detailed analysis at the diagnosis group level.ResultsOut of 12,434 enrolled inpatients (TH 6171 and NTH 6263), the majority (> 85%) received antibiotics. None of the inpatients received the recommended single-dose PAP. The average duration of antibiotic treatment was significantly longer at the TH compared to the NTH (9.5 vs 4.4 days, p < 0.001). Based on the study aim, 5984 patients were classified in four diagnosis groups: upper or lower urinary tract surgery indications (UUTSI and LUTSI), and routine or emergency abdominal surgery indications (RASI and EASI). In both hospitals, quinolones were the most prescribed antibiotics for UUTSI (TH 70%, NTH 37%) and LUTSI (TH 70%, NTH 61%) antibiotic. In the TH, aminoglycosides (TH 32%) were commonly prescribed for RASI and imidazole derivatives (75%) for EASI. In the NTH, cephalosporins (39%) and imidazole derivatives (56%) were the most prescribed in RASI and EASI, respectively.Conclusions and recommendationsHigh prescribing of antibiotics in all four selected diagnoses groups was observed at both hospitals. In spite of the recommended single-dose PAP, antibiotics were mainly prescribed for longer durations. The unrecommended use of antibiotics is a risk factor for the development of AMR. Improving the quality of antibiotic prescribing by a stewardship program focusing on the development and implementation of local prescribing guidelines is needed.
Highlights
Single-dose perioperative antibiotic prophylaxis (PAP) is recommended for clean, non-infectious surgeries to prevent surgical site infections
Antibiotic prescribing at the department level Among 12,992 enrolled inpatients, 6315 were admitted at the rural (TH) and 6677 at the urban hospital (NTH, Fig. 1)
Antibiotics were prescribed to 88% inpatients in the TH and 86% in the NTH
Summary
Single-dose perioperative antibiotic prophylaxis (PAP) is recommended for clean, non-infectious surgeries to prevent surgical site infections. The common practice of unindicated use and prolonged use of antibiotics contributes to the development and spread of antibiotic resistance (ABR). Antibiotic resistance (ABR) is a definite result of antibiotic use and a condition when common infections or minor injuries can turn into life-threatening situations. Unavailability or poor implementation of antibiotic prescribing guidelines and constrained resources are major contributors to the development and spread of ABR. Development of local prescribing guidelines based on surveillance of antibiotic prescribing and resistance patterns is recommended. Various strategies have been applied globally, to improve prescribing and compliance, such as computerized registers for the surveillance and follow-up of the prescriptions and offering financial incentives to the prescribers (Gould 2002; Bou-Antoun et al 2018). Manual collection of antibiotic prescribing data for a long time period even with the help of available World Health Organization (WHO) tools is an expensive, time-consuming, and cumbersome process (World Health Organization 2017a)
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