Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital

Surgical site infection and antimicrobial prophylaxis prescribing profile, and its determinants among hospitalized patients in Northeast Ethiopia: a hospital based cross-sectional study

The inappropriate use of surgical antimicrobial prophylaxis is a common cause for increased risk of morbidity and mortality from surgical site infection in patients who underwent surgical procedures. The study aimed to evaluate surgical antimicrobial prophylaxis prescribing patterns, Surgical Site Infection (SSI), and its determinants in the surgical ward of Debre Berhan Comprehensive Specialized Hospital, northeast Ethiopia. A prospective cross-sectional study was conducted from October 1st 2022 to January 31st, 2023. Data collected from patient medical record cards and patient interviews were entered and analyzed using SPSS V26.0. The determinants of surgical site infection were determined from the multivariable logistic regression. P-value ≤ 0.05 was considered statistically significant. Ceftriaxone (70.5%) followed by a combination of ceftriaxone with metronidazole (21.90%) was the most frequently used prophylactic antibiotic. One hundred fifty-nine (78%) of patients were exposed to inappropriately used prophylactic antimicrobials and 62.2% of these were exposed to inappropriately selected antibiotics. One hundred twenty-six (61.9%) patients developed Surgical Site Infection (SSI). Duration of procedure longer than an hour and inappropriate use of antimicrobial prophylaxiswere the independent predictors for the occurrence of surgical site infections. Patients whose operation was lasted in longer than an hour were 3.39 times more likely to develop SSI compared to those whose operation was completed in less than an hour, AOR = 3.39 (95% CI: 1.24-9.30). Similarly, controlling the effect of other covariate variables, individuals who were given inappropriate antimicrobial prophylaxis were 6.67 times more likely to develop SSI compared to those given appropriate prophylaxis, AOR = 6.67 (95% CI: 1.05-42.49). The high rate of SSI requires due attention from clinicians as well as health policymakers. Duration of surgical procedure greater than an hour and inappropriate antimicrobial prophylaxis use was the independent predictor of surgical site infections.

Antibiotic Usage in Surgical Prophylaxis: A Retrospective Study in the Surgical Ward of a Governmental Hospital in Riyadh Region

Antibiotic prophylaxis is used to decrease the bacterial load in the wound to assist the natural host defenses in preventing the occurrence of surgical site infections. The present study aimed to investigate trends in using antibiotic prophylaxis in the surgical ward of a governmental hospital in the Riyadh Region and included collecting data concerning the use of antibiotic prophylaxis from medical electronic records. During 2020, most of the surgical patients received systemic antibiotics (82.40%). The most prescribed antibiotics were ceftriaxone (28.44%) and metronidazole (26.36%). The study also found that most of the patients received antibiotics for seven days or for five days, and only 1.08% of the patients received antibiotics appropriately for a maximum of one day. The present study showed that there was a major problem in selecting the correct antibiotic and in the duration of its use compared with the recommendations of the surgical prophylaxis guideline that was issued by the Saudi Ministry of Health. Thus, there is an urgent need to improve the adherence to the recommendations of surgical antibiotic prophylaxis guidelines in order to reduce the occurrence of negative consequences.

The Impact of a Multidisciplinary Approach Protocol and Integrated Guidelines for Antibiotic Prophylaxis in Plastic Surgery Procedures

BACKGROUND

Surgical antibiotic prophylaxis has been widely used for prevention of surgical site infections (SSI's). World Health Organization (WHO) global guidelines strongly recommend the administration of pre-operative prophylactic antibiotic, depending on the type of surgery, to reduce SSI's. However, within Gulf Cooperation Council (GCC) countries, antibiotic resistance has been rising due to unregulated prescribing practice. We aimed to assess adherence to local/international guidelines in the plastic surgery unit of Salmaniya Medical Complex.

METHODS

This study was a retrospective review of adults' undergoing plastic surgery between the dates of 1^st of January 2019 to 30^th of April 2019. Recommendations and guidelines were provided by South Australian Guidelines for Surgical Antimicrobial Prophylaxis, NHS Greater-Glasgow Foundation Trust. Salmaniya Medical Complex Guidelines were also taken into consideration. This was followed by an implementation of standardized guidelines and a re-assessment period for another four months.

RESULTS

There were 106 patients who met the inclusion/exclusion criteria throughout the primary cohort. With respect to choice and dose of antibiotics, only 21 (19.8%) of the procedures were adherent to global/local guidelines. Similarly, only 11.5% of those cases have met the recommended timing for pre-operative antibiotic administration. After the implementation period, adherence to guidelines regarding choice and time of antibiotic administration has increased to 36.8% and 32.6% respectively. SSI decreased from 1.8% to 0.08%.

CONCLUSION

Practice in SMC in plastic surgery pre-operative antibiotic prophylaxis shows poor compliance to both local and international guidelines in terms of choice, dose, and time of administration. We were able to significantly improve adherence to international/local practice in both areas by implementing an integrated protocol in liaison with the medical staff involved in the plastic surgery unit and operating theatres.

Fatores de risco para infecção de sítio cirúrgico em cirurgias traumato-ortopédicas

Introdução: A Infecção do Sítio Cirúrgico ocupa a terceira posição entre as infecções adquiridas em serviços de saúde, configurando-se como um importante problema de saúde pública, presente em cerca de 15% daquelas encontradas em pacientes hospitalizados, e um dos tipos de cirurgias de maior probabilidade para esse evento são as traumato-ortopédicas. Objetivo: Verificar a associação entre os fatores de risco e a presença de Infecção de Sítio Cirúrgico em cirurgias traumato-ortopédicas. Materiais e métodos: Estudo prospectivo descritivo, quantitativo, realizado entre agosto a outubro de 2017 com 84 pacientes. Os dados referentes ao paciente, ao procedimento e os sinais de Infecções de Sítio Cirúrgico, encontrados no terceiro e décimo dia de pós-operatório, foram coletados por meio de um formulário. Resultados: Das variáveis estudadas, comportaram-se como fatores de risco de Infecção de Sítio Cirúrgico: tabagismo, diabetes e idade acima de 50 anos. A idade foi o principal fator de risco relacionado ao paciente, presente em 31, 36,9% dos casos. Dor, edema e hiperemia foram os sinais de infecção mais prevalentes. Discussão e conclusões: Os fatores de risco relacionados ao paciente possuem maior relevância na associação com infecção do sítio cirúrgico em comparação com os relacionados ao procedimento.

Effect of surgical safety checklist on colorectal surgical site infection rates in 2 countries: Brazil and Canada

BACKGROUND

The effectiveness of the surgical safety checklist (SSC) in countries with different socioeconomic backgrounds is uncertain. To evaluate the effect of the SSC in 2 different socioeconomic settings, we compared surgical site infection (SSI) rates before and after its implementation in colorectal procedures.

METHODS

An epidemiological retrospective study was conducted in the university hospitals in Ottawa, Canada, and Belo Horizonte, Brazil. Data were collected through chart review from the period before and after the SSC implementation.

RESULTS

The SSI rate decreased from 27.7%-25.9% (P = .625) and from 17.0%-14.4% in Canada and Brazil, respectively (P = .448) after the SSC implementation. In Canada, there was no SSI in incomplete SSC, and in Brazil, SSI was 20.0% (P = .026).

DISCUSSION

Despite high and regular completion of the SSC in the Canadian and Brazilian hospitals, respectively, there was no significant reduction of SSI after the SSC implementation in any setting. However, in Brazil, the association between incomplete SSC and higher SSI rates demonstrated the potential impact of the SSC in developing countries.

CONCLUSIONS

The effect of the SSC on SSI may be greater in developing countries due to minor investment and consolidation of policies in SSI prevention.