Compliance to pre-operative antimicrobial prophylaxis and incidence of surgical site infection in a tertiary care hospital

Context: Surgical site infections (SSIs) are a major post-operative complication. Surgical antimicrobial prophylaxis (SAP) significantly lowers the incidence of SSIs. Aims: The study aims to evaluate the compliance to SAP guidelines with the incidence of SSIs and to identify the risk factors associated with SSIs. Settings and Design: A retrospective case–control study was conducted in a tertiary care hospital, which included all cases that required surgical intervention from January 2016 to December 2022. Materials and Methods: Main SAP practices, that is, choice, timing, re-dosing and total duration of SAP compliance, were analysed. Statistical Analysis Used: SPSS V25 multivariate logistic regression analysis was carried out to identify the risk factors of SSIs. Results: Non-compliance towards choice ( P = 0.023), re-dosing ( P = 0.004) and post-operative duration of SAP ( P < 0.001) had a significant effect, whilst timing of SAP ( P = 0.18) had a less significant effect in patients who developed SSIs. On multivariate analysis, incorrect choice of antibiotics (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.0–2.8), inappropriate duration of post-operative SAP (OR: 1.6, 95% CI: 1.1–2.3), diabetes mellitus (OR: 1.9, 95% CI: 1.2–2.9), malnourished (OR: 3.07, 95% CI: 1.0–8.2), obese (OR: 5.14, 95% CI: 3.0–8.6), hypoalbuminemia (OR: 1.7, 95% CI: 1.0–2.7), duration of surgery >4 h (OR: 4.2, 95% CI: 2.6–6.7) and American Society of Anesthesiologists score >1 (OR: 2.1, 95% CI: 1.2–3.7) were found to be independent risk factors of SSIs. Conclusions: The study found that adherence to SAP guidelines is essential in preventing SSIs.