ASSESSMENT OF APPROPRIATENESS AND GUIDELINE COMPLIANCE OF SURGICAL ANTIMICROBIAL PROPHYLAXIS IN ELECTIVE GENERAL SURGERY: A RETROSPECTIVE OBSERVATIONAL STUDY
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Keywords
Surgical antimicrobial prophylaxis, guideline adherence, elective surgery, antimicrobial stewardship, retrospective study, antibiotic audit.
Abstract
Background:Surgical antimicrobial prophylaxis (SAP) remains a cornerstone in reducing surgical site infections (SSIs) in elective general surgical procedures. Despite well-established international recommendations, deviations in antibiotic selection, timing, and duration continue to be reported, contributing to antimicrobial resistance and unnecessary healthcare expenditure. Periodic institutional audits are essential to evaluate compliance and promote rational prescribing practices.
Objectives:To evaluate the appropriateness and guideline adherence of surgical antimicrobial prophylaxis in patients undergoing elective general surgical procedures at a tertiary care teaching hospital.
Methods:A retrospective observational study was conducted by reviewing medical records of 180 patients who underwent elective general surgical procedures between January and December 2018. Data collected included demographic profile, type of surgery, antibiotic selection, timing of administration, dosage, route, and duration of prophylaxis. Appropriateness was assessed based on established international guidelines for surgical antimicrobial prophylaxis. Compliance rates were calculated for antibiotic choice, timing (within 60 minutes before incision), and duration (≤24 hours postoperatively). Descriptive statistics were used for analysis.
Results:Among 180 patients analyzed, cephalosporins were the most commonly prescribed prophylactic agents (72.2%), followed by beta-lactam/beta-lactamase inhibitor combinations (18.9%). Appropriate antibiotic selection was observed in 68.3% of cases, while correct timing of administration was documented in 74.4% of patients. However, prolonged postoperative antibiotic use beyond 24 hours was identified in 61.1% of cases. Overall full guideline compliance (selection, timing, and duration) was achieved in 42.8% of patients. The observed surgical site infection rate was 6.1%, with higher incidence among cases receiving prolonged prophylaxis.
Conclusion:The study demonstrates suboptimal adherence to surgical antimicrobial prophylaxis guidelines, particularly concerning duration of antibiotic administration. Institutional antimicrobial stewardship initiatives and standardized perioperative protocols are necessary to improve rational antibiotic use and minimize preventable antimicrobial exposure.
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Dr Kishor D Wani
MBBS MS Surgery Associate professor Department of Surgery Dr Vasantrao Pawar Medical College Hospital & Research Centre Nashik
