Practice of prophylactic antibiotic and timing of administration in two common elective surgeries in Pakistan: An audit-based study

Abstract

Antibiotic prophylaxis usage is one of the main actions to prevent and reduce rate of surgical site infections. Antimicrobial stewardship programme is also focused on audit of surgical antibiotic prophylaxis (SAP). The objective of study was to evaluate the appropriateness of SAP and their pattern of utilization in two tertiary-care teaching hospitals in Islamabad (Pakistan). A total of 965 elective surgeries were performed during the 9 months study period. The two most common elective surgical procedures were Laparoscopic cholecystectomy and Direct right inguinal hernia, that were performed on 443 patients. Adherence to the Standard International Guidelines (CDC, 2017) about appropriate use of antibiotic and timing of administration were main outcomes. The mean age of patients was 43.5±16.3 years. SAP was appropriate according to guidelines in only 5% (n=22) of cases. Appropriate use of SAP was greater in direct right inguinal hernia (10%) than laparoscopic cholecystectomy (1.2%) surgery; P = 0.001. The drug of choice cefazolin was only prescribed to 4.2% (19 out of 443) of patients. Timing of administration was appropriate in 50.8% (225 out of 443) of the procedures. Compliance with timing was significantly lower in Hospital GH (32%) as compared to Hospital PH (71%); P < 0.001. Length of stay was significantly different (P = 0.001) between surgical procedures. The most common antibiotics used inappropriately were ceftriaxone and Cefuroxime. Present study found an overall low adherence to SAP mainly regarding choice and timing of administration. Educational intervention and urgent need for implementation of antimicrobial stewardship programme are required.