Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital

Abstract

Background: Surgical antimicrobial prophylaxis guidelines are considered as important interventional tools for antimicrobial resistance. Guideline compliance was poor across different countries and thus results in an inappropriate and overuse of antibiotics.

Objective: To evaluate the selection, timing and duration of prophylactic antibiotic administration among surgical patients in Nekmte referral hospital.

Method: Prospective, facility based cross-sectional study was conducted from 1st April to 30th June 2017. Data were collected using data abstraction format among surgical inpatients prescribed with surgical antibiotic prophylaxis. Surgical antimicrobial prophylaxis guidelines were used as data assessment protocols. SPSS version 21.0 was used for data entry and analysis. Descriptive statistics and binary logistic regression were used for analysis.

Results: The median age of the study participants was 35.0 (IQR: 25-50) years with the preponderance (58.8%) of male patients. The median hospitalization period was 8.0 (IQR: 5-11) days. Majority of the participants were from the general surgical ward (60.1%). About 43% of the procedures were clean. Most of the surgical cases were gastrointestinal (39.2%). Only 10.6% of the drug selections comply with American Society of Health-System Pharmacists guideline. Surprisingly, none of the selections were compliant to the national Standard Treatment Guideline of the country. About 84% of the study participants received ceftriaxone. Majority of the prophylactic antibiotics (75.8%) were administered for greater than 24 hours and above half (52.3%) of the antibiotics were administered preoperatively. Emergent surgery procedures (AOR = 2.89, 95% CI: (1.09-9.10) and being a male patient (AOR = 3.10, 95% CI: 1.07-8.98) were associated with inappropriate preoperative antibiotic administration. Patients admitted to the gynecology and obstetrics ward was less likely to receive surgical prophylaxis for greater than 24 hours (AOR = 0.07, 95% CI: 0.01-0.81).

Conclusion: Surgical antibiotic compliance was far below the guideline recommendation. Patients admitted in the gynecology and obstetrics ward were more likely to comply with the surgical antimicrobial prophylaxis duration recommendation. The timing was most likely to be inappropriate among male patients and patients on emergent surgery. Availability and awareness creation on the antibiotic drugs and the guidelines were important interventions recommended for appropriate surgical antimicrobial use.

Fig 1. Number of cases that can be addressed as per the guidelines if cefazolin is available among surgical patients in NRH from 1^st April to 30^th June 2017.

STG: standard treatment guideline; ASHP: American society of health-system pharmacists.