Does appropriate preoperative antibiotic prophylaxis reduce 30-day surgical site infections in general surgery patients?
Adherence to evidence-based preoperative antimicrobial prophylaxis guidelines significantly reduces the risk of 30-day surgical site infections.
Surgical site infections (SSIs) remain a significant healthcare challenge, with preoperative antibiotic prophylaxis serving as a critical prevention strategy. This audit evaluated current prophylaxis practices and their effectiveness in reducing postoperative infections at a tertiary care institution. Methods: A prospective observational study was conducted at the Department of General Surgery, A.S.J.S.A.T.D.S Medical College, Fatehpur, Uttar Pradesh, India, from December 2023 to December 2024. Five hundred surgical patients were systematically sampled and evaluated for adherence to evidence-based prophylaxis guidelines and 30-day SSI outcomes. Data collection included patient demographics, comorbidities, details of antimicrobial administration, and postoperative infection surveillance. Statistical analysis employed chi-square tests, t-tests, and multivariable logistic regression. Results: The overall SSI rate was 9.4% (47/500 patients). Only 46.8% of patients received appropriate antibiotic prophylaxis in accordance with established guidelines. Optimal timing (within 60 minutes before incision) was achieved in 59.6% of cases. Patients receiving appropriate prophylaxis demonstrated significantly lower SSI rates compared to those with inappropriate prophylaxis (5.1% vs. 15.8%, p < 0.001), representing a 67.7% reduction in the risk of SSI. Independent risk factors for SSI included advanced age (OR 1.04, 95% CI 1.02-1.06), diabetes mellitus (OR 2.41, 95% CI 1.33-4.37), obesity (OR 1.93, 95% CI 0.98-3.82), and contaminated/dirty surgical procedures (OR 3.15, 95% CI 1.71-5.81). Timing of administration showed a dose-response relationship, with SSI rates increasing from 5.0% for optimal timing to 24.2% for post-incision administration. Conclusion: Significant gaps exist in adherence to evidence-based prophylaxis guidelines, resulting in preventable SSIs. Implementation of standardized protocols and antimicrobial stewardship programs could substantially improve surgical outcomes and reduce healthcare costs.
Shyam Gopal Verma (Wed,) studied this question.