Compliance of surgical antimicrobial prophylaxis practices in the departments of general surgery and orthopaedics at a tertiary care centre in India
DOI:
https://doi.org/10.18203/2349-3933.ijam20203996Keywords:
AM, Antibiotic, Antimicrobial prophylaxis, Antimicrobial stewardship practices, ComplianceAbstract
Background: Antimicrobial (AM) prophylaxis is one of the major interventions to prevent surgical site infections. The guideline recommendations are meant for helping the surgeons to select the rationale and effective approach while. This study aimed to assess the compliance of surgical AM prophylaxis in terms of choice of antibiotic, duration and timing of administration using standard international and national guidelines.
Methods: A prospective observational study was done in General Surgery and Orthopaedics over a period of one year. All the relevant data was collected and analysed. Results were then compared with standard Clinical Practice Guidelines (CPGAS-2013 and ICMR-2017).
Results: In terms of choice of AM, 31.32% of the cases from general surgery and 97.59% of the cases from orthopaedics according to ICMR 2017 guidelines; 28.91% of the cases from general surgery and none of the cases from orthopaedics according to CPGAS 2013 guidelines were found to be compliant. In terms of duration of prophylaxis, 28.91% and 22.89% of the cases from general surgery were found to be compliant to ICMR 2017 and CPGAS 2013 guidelines respectively; but none of the cases from orthopaedics were compliant to either of the guidelines. Timing of administration was found to be compliant with the guidelines in both the departments.
Conclusions: Surgical prophylaxis practices were found to be partially compliant with the guidelines in the selected departments.
References
Walia K, Ohri VC, Madhumathi J, Ramasubramanian V. Policy document on antimicrobial stewardship practices in India. Indian J Med Res. 2019;1;149(2):180-4.
Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA et al. Global antibiotic consumption 2000 to 2010: An analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14(8):742-50.
Surgical Antimicrobial Prophylaxis Clinical Guideline. Cited from https://www.ashp.org/-/media/assets/policy-guidelines/docs/therapeutic-guidelines/therapeutic-guidelines-antimicrobial-prophylaxis-surgery.ashx. Accessed on 20 May 2020.
Treatment Guidelines for Antimicrobial Use in Common Syndromes. 2017.cited from http://bic.icmr.org.in/iamrsn/images/pdf/STG270217.pdf. Accessed on 20 May 2020.
Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. ASHP Therapeutic Guidelines; 734-812.cited from https://www.ashp.org/-/media/assets/policy-guidelines/docs/therapeutic-guidelines/therapeutic-guidelines-antimicrobial-prophylaxis-surgery.ashx. Accessed on 20 May 2020.
de With K, Allerberger F, Amann S, Apfalter P, Brodt HR, Eckmanns T et al. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection. 2016;1;44(3):395-439.
Andrajati R, Vlček J, Kolar M, Pípalová R. Survey of surgical antimicrobial prophylaxis in Czech Republic. Vol. 27, Pharmacy World and Science. Springer Netherlands. 2005;436–41.
Fennessy BG, O’Sullivan MJ, Fulton GJ, Kirwan WO, Redmond HP. Prospective study of use of perioperative antimicrobial therapy in general surgery. Surg Infect. 2006;7(4):355-60.
Afzal Khan AK, Mirshad P V, Rashed MR, Banu G. A study on the usage pattern of antimicrobial agents for the prevention of surgical site infections (SSIs) in a tertiary care teaching hospital. J Clin Diagn Res. 2013;7(4):671-4.
Onyekwelu I, Yakkanti R, Protzer L, Pinkston CM, Tucker C, Seligson D. Surgical Wound Classification and Surgical Site Infections in the Orthopaedic Patient. JAAOS Glob Res Rev. 2017;1(3):e022.
Mboya EA, Sanga LA, Ngocho JS. Irrational use of antibiotics in the moshi municipality Northern Tanzania: A cross sectional study. Pan Afr Med J. 2018;31.
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283.
Kulkarni RA, Kochhar PH, Dargude VA, Rajadhyakshya SS, Thatte UM. Patterns of antimicrobial use by surgeons in India. 2005;67.
Kamath SG, Varun HV, Rani DU, Aithal S, Patil UN. Prescribing patterns of antimicrobials in surgical departments in a tertiary care hospital in south India. Int J Pharmace Sci Res. 2014;5(3):1051-8.
Sipahi OR. Economics of antibiotic resistance. Vol. 6, Expert Review of Anti-Infective Therapy. 2008;523-39.
Nagdeo N, Sonarkar R, Thombare VR, Akhtar M, Dasgupta S. Effects of an Educational Module in Rationalizing Surgical Prophylaxis. Indian J Surg. 2015;77(4):290-6.
Hosoglu S, Sunbul M, Erol S, Altindis M, Caylan R, Demirdag K. A National Survey of Surgical Antibiotic Prophylaxis in Turkey. Infect Control Hosp Epidemiol. 2003;24(10):758-61.
Ayele Y, Taye H. Antibiotic utilization pattern for surgical site infection prophylaxis at Dil Chora Referral Hospital Surgical Ward, Dire Dawa, Eastern Ethiopia. BMC Res Notes. 2018 ;11(1):537.
Kaya S, Aktas S, Senbayrak S, Tekin R, Oztoprak N, Aksoy F et al. An Evaluation of Surgical Prophylaxis Procedures in Turkey: A Multi-Center Point Prevalence Study. Eurasian J Med. 2016;48(1):24-8.
Musmar SM, Ba`ba H, Owais A. Adherence to guidelines of antibiotic prophylactic use in surgery: a prospective cohort study in North West Bank, Palestine. BMC Surg. 2014;14(1):69.
Al-Momany NH, Al-Bakri AG, Makahleh ZM, Wazaify MMB. Adherence to international antimicrobial prophylaxis guidelines in cardia surgery: A Jordanian study demonstrates need for quality improvement. J Manag Care Pharm. 2009;15(3):262-71.
Vessal G, Namazi S, Davarpanah MA, Foroughinia F. Evaluation of prophylactic antibiotic administration at the surgical ward of a major referral hospital, Islamic Republic of Iran. East Mediterr Health J. 2011;17(08):663-8.
Shah A, Gajjar B, Shankar R. Antibiotic utilization for surgical prophylaxis in a tertiary care teaching rural hospital. International Journal of User-Driven Healthcare. 2011;1(4):1-14.
Jaggi N, Nirwan P, Chakraborty M. Adherence to surgical antibiotic prophylaxis guidelines in an Indian tertiary care hospital. J Patient Saf Infect Control. 2018;6(1):13.
Mathur P, Trikha V, Farooque K , Sharma V, Jain N, Bhardwaj N et al. Implementation of a short course of prophylactic antibiotic treatment for prevention of postoperative infections in clean orthopaedic surgeries. Indian J Med Res. 2013;137:111-6.