Short course antibiotic prophylaxis to prevent surgical site infections in HPB surgeries. Are we giving too much? A prospective study

Abstract

Introduction: Use of antibiotics in perioperative period is common practice to prevent septic complications and surgical site infections. Methods: We prospectively evaluated protocol of single dose preoperative antibiotic for laproscopic surgeries and 48-h prophylactic antibiotic for open hepato-pancreatico-biliary surgeries. Surgical Site infections were defined as any culture positive discharge from the main surgical wound or complications like bile leaks through the wound or drain. Categories of surgeries were decided according to CDC protocol. Results: Out of 94 patients 2 patient had undergone grade 1 (clean) surgery, 43 patients grade 2 surgery (clean contaminated), 28 patients grade 3 (contaminated) surgery, and 8 patient had grade 4 (dirty) surgery. Total 11 patient developed surgical site infections giving over all SSI rates of 11.7 percent. No Patients in grade 1 or grade 2 surgeries developed surgical site infections. 9 patients in grade 3 (32 percent) surgeries and 3 patient in grade 4 (37.5 percent) surgeries developed surgical site infections. No patient in laproscopic surgery group developed surgical site infections, which is comparable to international data. Open surgery was significantly associated with SSI rates(p = 0.04). Contaminated and dirty (grade 3 and grade 4) surgeries were significantly associated with surgical site infections. (p = 0.030). morbidity and mortality rates were 13.8 percent and 9.4 percent respectively. SSI was significantly associated with grade-3, grade-4 complications. (p < 0.01) and mortality (p < 0.01). Conclusion: Short course prophylactic antibiotics protocol has similar SSI rates and can reduce hospitalization and cost. Short course prophylactic antibiotic protocol also helps in reducing antimicrobial resistance.