Key result
Surgical antibiotic prophylaxis guideline compliance falls below 1%, driven by inappropriate antibiotic selection.
Why the study?
There is a gap between national and international guidelines for surgical antibiotic prophylaxis and its clinical application in a tertiary care teaching hospital in India.
Cohort (n=394)
No
There is a significant gap between surgical antibiotic prophylaxis guidelines and clinical practice in this Indian tertiary care hospital, with overall compliance being less than 1%.
Suboptimal SAP guideline compliance in this Indian cohort; leaves open whether stewardship programs improve adherence and outcomes in similar settings.
Surgical antibiotic prophylaxis (SAP) has been a boon in the prevention of surgical site infections (SSIs). This study was conducted to assess and evaluate the selection, timing, and duration of administration of SAP and their compliance with national and international guidelines in a tertiary care teaching hospital in India. This retrospective study included the data collected from the central records department in a tertiary care teaching hospital on major surgeries conducted between January 1, 2018, and December 31, 2018, from the departments of ENT, general surgery, orthopedic surgery, and obstetrics and gynecology. The data was analyzed for the appropriateness of their indication for SAP administration, choice, timing, and duration of antibiotics, and compliance with the American Society of Health-System Pharmacists (ASHP) and Indian Council of Medical Research (ICMR) guidelines. Results and interpretation Out of the total 394 case records included, only 2.53% (n = 10) of the cases were given an appropriate antibiotic. The duration of SAP was appropriate only in 6.53% (n = 24), and the timing of SAP administration was appropriate only in 50.76% (n = 204). The most commonly used antibiotic was ceftriaxone (pre-operative 58.12% (n = 229) and post-operative 43.14% (n = 170)). Major inappropriateness was observed in the selection of antibiotics which may be attributed to the non-availability of cefazolin in the institute. The inappropriateness of the duration of the SAP may be attributed to the extra precautions taken by the treating physicians to prevent SSIs. The overall compliance of the surgical cases with respect to the ASHP and ICMR guidelines was less than 1%. Conclusion This study identified the lacuna between the guidelines for SAP and the clinical application of the same. It also identified the areas where quality improvement was needed which can be improved by implementing antimicrobial stewardship, especially the choice and the duration of SAP administration.
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Gurunthalingam et al. (2023) conducted a cohort in Major elective surgeries (n=394). Surgical antibiotic prophylaxis vs. ASHP and ICMR guidelines was evaluated on Appropriateness of selection of surgical antibiotic prophylaxis. Overall compliance with surgical antibiotic prophylaxis guidelines was less than 1%, with appropriate antibiotic selection occurring in only 2.53% of cases.
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