Appropriateness of choice and duration of surgical antibiotic prophylaxis and the incidence of surgical site infections: A prospective study

Abstract

Objectives: Surgical site infections (SSIs) develop within 30e90 days postoperatively. Antibiotic prophylaxis helps reduce SSI incidence, with cefazolin being the most used agent. Current guidelines recommend against postoperative antibiotic administration or a very short course. This study evaluated the appropriateness of prophylactic antibiotics by surgery type, as well as duration and their impact on SSI incidence. Methods: This was an observational prospective study of adults admitted between June and October 2019 for abdominal or orthopedic surgery who received prophylactic antibiotics. The primary endpoint was compliance of postoperative prophylactic antibiotic duration with the guidelines. Secondary endpoints included appropriateness of antibiotic choice and SSI rates. Results: Of the 98 patients, 59, 23, and 16 had orthopedic, upper abdominal, and lower abdominal surgery, respectively. Median postoperative antibiotic durations were longer in the abdominal surgery group than in the orthopedic surgery group (7 vs. 5 days; P ¼ 0.03). Hence, overall compliance with the guidelines in terms of postoperative antibiotic duration was 11.2% (13.6%, 13%, and 0% in each surgery group, respectively; P ¼ 0.3). Conversely, antibiotic choice was highly compliant with the guidelines at 71.4% (72.9%, 65.2%, and 75% in each surgery group, respectively; P ¼ 0.74). This was significantly associated with a lower risk of SSIs (odds ratio 0.24, 95% confidence 0.09e0.63). Conclusion: While there was a lack of guidelines compliance in terms of duration, appropriateness of antibiotic choice was high and was associated with a lower likelihood for SSIs. Clinicians are encouraged to follow the guidelines to improve patients’ quality of care by preventing SSIs and reducing the risk of antimicrobial resistance development.