Background: Surgical antimicrobial prophylaxis (SAP) is critical for preventing surgical site infections (SSIs). However, inappropriate use of SAP contributes to antibiotic resistance. This study evaluated compliance with the American Society of Health-System Pharmacists (ASHP) SAP guidelines at a tertiary care hospital in India and assessed the implications for SSI prevention and antimicrobial stewardship. Methods: A prospective observational study was conducted from June–August 2024, analyzing 95 surgical cases. SAP practices were audited against the ASHP guidelines for five parameters: indication, antibiotic choice, timing (pre-incision 30–60 min), route (IV), and duration (< 24h postoperatively). Data were collected systematically from electronic records and analyzed for compliance rates. Results: Overall, adherence to the SAP guidelines was 99.4%, and compliance was highest for antibiotic selection (100%), dosing (100%), and postoperative duration (100%). Preoperative timing compliance was 97%, while 6% received unjustified prophylaxis. Elective surgeries (67%) predominated, with ceftriaxone (31%) and cefuroxime (31%) being the most prescribed antibiotics. Moreover, a significant gender disparity was observed, mostly (76%) in male patients. Conclusion: Tear-perfect compliance with the SAP guidelines is achievable in resource-limited settings, demonstrating that strict adherence to the ASHP guidelines minimizes unnecessary antibiotic use while maintaining SSI prevention efficacy. The 6% unjustified prophylaxis rate highlights an opportunity for stewardship refinement. These findings provide a replicable model for optimizing SAP in global surgical practice.
Khan et al. (Fri,) studied this question.