Prescription analysis of drug prescribed in post-operative period in a teaching hospital in Bhilai, Chhattisgarh, India

Background: Surgical site infections are associated with prolonged hospital stays and increased cost of therapy. Prophylactic use of antimicrobials is to prevent the incidence of postoperative wound infection. To generate data on postoperative use of antimicrobials this study was planned.Methods: The information was collected in semi-structured questionnaire format from the patient’s case paper. Information regarding the antimicrobials prescribed by surgeon, including drug combinations, duration of therapy, frequency of drug administration, and diagnosis for the surgery was collected. Surgical wounds were classified based on National Research Council (NRC) criteria.Results: Mean duration of antibiotic use was 3.71 days for clean surgeries (70%) and ranging from 2.67 days to 6 days for clean contaminated, contaminated and dirty types of surgeries. average number of antimicrobials prescribed for surgical antimicrobial prophylaxis was 3 per patients. Ceftriaxone, cefixime, ofloxacin, levofloxacin, amikacin, amoxycillin + clavulanic acid, ampicillin, metronidazole were used for postoperative prophylaxis.Conclusions: As per guidelines, the usage of antibiotics was found to be inappropriate in some conditions. Third generation cephalosporin was the preferred or most prescribed choice of drug for postoperative prophylaxis. The average number of antimicrobials prescribed for postoperative prophylaxis was 3 per patients.

Download Full-text

Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01693-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Güzin Surat ◽

Dominik Bernsen ◽

Christoph Schimmer

Keyword(s):

Cardiac Surgery ◽

Antimicrobial Stewardship ◽

Antimicrobial Prophylaxis ◽

Tertiary Care ◽

Surgical Site Infections ◽

Antibiotic Use ◽

P Value ◽

Care Hospital ◽

Surgical Antimicrobial Prophylaxis ◽

Sternal Wound Infections

Abstract Objective The goal of this study was to monitor the compliance and impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery favouring cefazolin instead cefuroxime, initiated by the hospital’s antimicrobial stewardship team. Methods This quality improvement study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the hospitals antimicrobial stewardship team following a revision of the standard for surgical antimicrobial prophylaxis including 1029 patients who underwent cardiac surgery. 582 patients receiving cefuroxime and 447 patients receiving cefazolin respectively were compared without altering any other preventative perioperative measures including its postoperative duration of less than 24 h. Adherence and surgical site infections were compiled and analysed. Results A complete adherence was achieved. Overall surgical site infections occurred in 37 (3.6%) of the cases, 20 (3.4%) in cefuroxime patients and 17 (3.8%) in cefazolin patients (p value = 0.754). No statistically significant differences could be found in any of the primary endpoints, but there was a trend towards less deep sternal wound infections in the cefazolin group. Conclusions The study supports the role of antimicrobial stewardship in cardiac surgery and mirrors the success of a multidisciplinary team aiming to minimize adverse events by optimizing antibiotic use.

Download Full-text

Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700075305 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1358-1365 ◽

Cited By ~ 2

Author(s):

Marisa I. Gómez ◽

Silvia I. Acosta-Gnass ◽

Luisa Mosqueda-Barboza ◽

Juan A Basualdo

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Final Stage ◽

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Site Infection ◽

Infection Rates ◽

Prospective Survey ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30]; P < .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55]; P < .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84]; P < .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79]; P < .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89]; P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

Download Full-text

Meta-analysis of the efficacy of ertapenem in preventing SSIs after elective colorectal surgery

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.697 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Vicentini ◽

A Corradi ◽

S Corcione ◽

F G De Rosa ◽

C M Zotti

Keyword(s):

Colorectal Surgery ◽

Antimicrobial Prophylaxis ◽

Meta Analysis ◽

Carbapenem Resistance ◽

Surgical Site Infections ◽

Resistant Isolate ◽

Elective Colorectal Surgery ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis ◽

Reported Data

Abstract Background The efficacy of standard surgical antimicrobial prophylaxis (SAP) regimens in preventing surgical site infections (SSIs) after colorectal surgery is declining, along with rising rates of intestinal colonization with antimicrobial resistant (AMR) Enterobacteriaceae and Bacteroides spp. Ertapenem has been approved by the FDA and EMA for SAP in this context, however it has not been used extensively for this indication out of concern for increasing carbapenem-resistance rates. A limited number of studies have investigated the efficacy of ertapenem in preventing SSIs after colorectal surgery, comparing ertapenem with different agents or combinations of agents. Methods A systematic review was conducted following the PRISMA checklist. PubMed, Embase and Cochrane databases were searched for studies measuring the efficacy of ertapenem in preventing SSIs following elective colorectal procedures. Studies were considered eligible if they reported extractable data on the proportion of SSIs and/or on the proportion of AMR pathogens isolated from SSIs. Data from all ertapenem study arms were extracted. A random effects meta-analysis was performed to estimate the overall proportion of SSI. Results Of 1109 identified studies, 5 met the inclusion criteria and were included in the meta-analysis, totalling 3176 participants. The pooled proportion of SSI was 0.10 (95% CI 0.05-0.18; I2=96%; τ2=0.6323; p ≤ 0.01). Only one study reported data on carbapenem resistance: out of 124 isolates from 30 patients, 1 gram negative carbapenem-resistant isolate was identified. Conclusions The pooled proportion of SSI using ertapenem as SAP found in this study is in line with the proportion of SSI using standard SAP found by a recent meta-analysis (Gandra, 2019). According to this analysis, the benefit of ertapenem does not outweigh the risk of further promoting AMR, although results should be interpreted with caution due to the high heterogeneity among included studies. Key messages According to this study, the efficacy of ertapenem in preventing surgical site infections after elective colorectal surgery is comparable to the efficacy of standard surgical antibiotic prophylaxis. The emergence of carbapenem resistance after surgical prophylaxis with ertapenem should be further investigated through longer term studies before widespread use for this indication.

Download Full-text

Antimicrobial Prophylaxis for the Prevention of Surgical Site Infections in Orthopaedic Oncology - A Narrative Review of Current Concepts

Journal of Bone and Joint Infection ◽

10.7150/jbji.39050 ◽

2019 ◽

Vol 4 (6) ◽

pp. 254-263 ◽

Cited By ~ 1

Author(s):

Daniel Müller ◽

Dominik Kaiser ◽

Kati Sairanen ◽

Thorsten Studhalter ◽

İlker Uçkay

Keyword(s):

Orthopaedic Surgery ◽

Antimicrobial Prophylaxis ◽

Surgical Techniques ◽

Surgical Site Infections ◽

Generation Cephalosporin ◽

Narrative Review ◽

Prophylactic Regimen ◽

Retrospective Case ◽

Antimicrobial Spectrum ◽

First And Second Generation

Abstract. The incidence of surgical site infections (SSIs) after elective tumour orthopaedic surgery in adults is higher than non-oncologic orthopaedic surgery. Their causative microorganisms and antibiotic susceptibilities are also different from the non-oncologic cases; with no apparent predictable microbiological patterns. Clinicians continue to struggle to tailor the optimal prophylactic regimen for the very heterogeneous group of tumour patients. Many clinicians thus prolong the first-and second-generation cephalosporin agents, while a minority chooses to broaden the antimicrobial spectrum by combination prophylaxis. The variability in current practices and surgical techniques is enormous, even within the same setting. The scientific literature lacks adequate retrospective case-studies and there is currently only one prospective randomized trial. In this narrative review, we discuss various perioperative antibiotic concepts in oncologic orthopaedic surgery, including a summary of the state-to-the-art, opinions and difficulties related to the different prophylactic strategies.

Download Full-text

Assessment of Prophylactic Antibiotic Use in Patients with Surgical Site Infections

Hospital Pharmacy ◽

10.1310/hpj4807-560 ◽

2013 ◽

Vol 48 (7) ◽

pp. 560-567 ◽

Cited By ~ 24

Author(s):

Whitney J. Goede ◽

Jenna K. Lovely ◽

Rodney L. Thompson ◽

Robert R. Cima

Keyword(s):

Antimicrobial Prophylaxis ◽

Prophylactic Antibiotic ◽

Surgical Care ◽

Control Unit ◽

Surgical Site Infections ◽

Perioperative Period ◽

Antibiotic Use ◽

Infection Prevention And Control ◽

Improvement Project ◽

Antibiotic Selection

Background Surgical site infections (SSIs) are the leading cause of hospital-acquired infections and are associated with substantial health care costs, with increased morbidity and death. The Surgical Care Improvement Project (SCIP) contains standards that are nationally reported with the aim of improving patient outcomes after surgery. Our institution's standards for antimicrobial prophylaxis in the perioperative period are more stringent than these measures and may be considered “beyond SCIP.” The 4 elements of appropriate antimicrobial prophylaxis are timing, antibiotic selection, dosing, and intraoperative redosing. Objective To quantify antimicrobial SSI prophylaxis compliance in accordance with institutional standards and to identify potential opportunities for improvement. Methods Patients aged 18 years or older were included if they had an SSI between January 1, 2009, and June 30, 2010, according to the database maintained prospectively by the Infection Prevention and Control Unit. Adherence to our institution's practice standards was assessed through analysis of antibiotics administered—timing in relation to the incision, closure, and tourniquet inflation times for the procedure and antibiotic selection, dose, and redosing. Results Overall noncompliance with all 4 elements of antimicrobial prophylaxis was 75.4% among the 760 cases. Repeat dosing had the greatest noncompliance (45.1%); antibiotic selection had the lowest incidence of noncompliance (10.8%). Conclusions Noncompliance existed in each element of antimicrobial SSI prophylaxis, with antibiotic redosing leading in noncompliance. With the implementation of tools to assist the surgical team in following institutional standards, noncompliance will likely decline and additional research opportunities will exist.

Download Full-text

Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

Infection Control and Hospital Epidemiology ◽

10.1086/509845 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1358-1365 ◽

Cited By ~ 23

Author(s):

Marisa I. Gómez ◽

Silvia I. Acosta-Gnass ◽

Luisa Mosqueda-Barboza ◽

Juan A Basualdo

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Final Stage ◽

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Site Infection ◽

Infection Rates ◽

Prospective Survey ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30];P< .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55];P< .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84];P< .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79];P< .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89];P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

Download Full-text

Prophylactic use of antibiotics as per SIGN 104 guidelines versus routine antibiotic prophylaxis for prevention of surgical site infection in clean and clean contaminated ENT surgical procedures: a comparative study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195698 ◽

2019 ◽

Vol 6 (1) ◽

pp. 106

Author(s):

M. Bharath ◽

J. R. Galagali ◽

Awadhesh Kumar Mishra ◽

Ajay Mallick ◽

E. Nikhilesh

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Surgical Procedures ◽

Antibiotic Use ◽

Site Infection ◽

Significant Difference ◽

Group A ◽

Prophylactic Use ◽

Group B ◽

Clean Contaminated

Background: Many clinicians continue to use antibiotic prophylaxis routinely in all surgical procedures, ignoring the guidelines issued by policy makers. In this prospective study we compared the rate of surgical site infection (SSI) in patients who received prophylactic antibiotics as a routine; with the rate of SSI in patients getting antibiotics strictly as per SIGN 104 Guidelines, for clean and clean contaminated procedures.Methods: The study population comprised 235 patients. Group A consisted of 119 patients having 77 (65%) males and 42 (35%) females while Group B had 116 patients - 71 (61%) males and 45 (39%) females. Group A received routine antibiotic prophylaxis in all cases, while Group B received antibiotic prophylaxis as per SIGN 104 guidelines only. Both the groups were followed up for one month post-operatively for SSI and complications.Results: SSI occurred in 2 patients (1.68%) in Group A and in 3 (2.59%) patients in Group B. There was no significant difference in the rate of SSI between the two groups (p=0.68). Procedure wise maximum SSI occurred in tympanoplasty and laryngectomy. Due to infection one case of tympanoplasty had graft failure and one case of laryngectomy had delayed wound healing. No major complications related to infection or antibiotic use occurred in either group.Conclusions: Selective use of antibiotic prophylaxis as per SIGN 104 Guidelines does not lead to increase in SSI in clean and clean contaminated ENT procedures.

Download Full-text

Retrospective Study of Infection Rate in Small Animal Surgery – of UBASMV Timișoara (2007-2017)

Bulletin of University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca Veterinary Medicine ◽

10.15835/buasvmcn-vm:2018.0037 ◽

2018 ◽

Vol 75 (2) ◽

pp. 231

Author(s):

Cornel IGNA ◽

Daniel BUMB ◽

Bogdan SICOE ◽

Larisa SCHUSZLER ◽

Cristian ZAHA

Keyword(s):

Antimicrobial Prophylaxis ◽

Companion Animals ◽

Small Animal ◽

Surgical Site Infections ◽

Important Concern ◽

Baseline Information ◽

Wound Classification ◽

Animal Surgery ◽

Clean Contaminated ◽

Surgical Clinic

Surgical site infections (SSIs) remain an important concern in veterinary practice. The purpose of this work was to determine the SSIs rate in the Surgery Clinic of the Faculty of Veterinary Medicine, Timișoara and to correlate SSIs incidence with surgical wound classification by degree of contamination and with the use of antimicrobial prophylaxis and / or applied therapy. Records of all animals operated on between 2007 and 2017 were closely checked for development of postoperative wound infection and were reviewed. The rate of surgical site infection was 0.77%, and by categories was 0.70% in clean surgeries, 0.15% in clean-contaminated surgeries, 1.76% in contaminated surgeries, and 1.08% in infected surgeries. Baseline information for SSIs surveillance in our surgical clinic and for comparison with other studies was defined. SSIs frequency in companion animals in our service is comparable with the frequency observed in another studies.

Download Full-text

Improving intraoperative administration of surgical antimicrobial prophylaxis: a quality improvement report

BMJ Open Quality ◽

10.1136/bmjoq-2020-001042 ◽

2020 ◽

Vol 9 (3) ◽

pp. e001042

Author(s):

Victoria Haney ◽

Stephan Maman ◽

Jansie Prozesky ◽

Dmitri Bezinover ◽

Kunal Karamchandani

Keyword(s):

Quality Improvement ◽

Antimicrobial Prophylaxis ◽

Surgical Care ◽

Surgical Site Infections ◽

Quality Improvement Initiative ◽

Antibiotic Administration ◽

Prescribing Practices ◽

National Guidelines ◽

Surgical Antimicrobial Prophylaxis ◽

Care Improvement

Despite widespread adoption of the Surgical Care Improvement Programme, the incidence of surgical site infections (SSIs) remains high. It is possible that lapses in appropriate administration of antimicrobial prophylaxis may play a role. We noted significant discordance with national guidelines with regards to intraoperative antibiotic administration at our institution, leading to implementation of a quality improvement initiative using multidisciplinary education and reminder-based interventions to improve prescribing practices and increase compliance with national guidelines. We observed a significant improvement in adherence to all aspects of antibiotic administration guidelines as a result of such interventions. Targeted multidisciplinary interventions may help improve prescribing practices of surgical antimicrobial prophylaxis and provide an opportunity to potentially decrease the burden of SSI and the related morbidity and mortality.

Download Full-text

Adherence of Surgeons to Antimicrobial Prophylaxis Guidelines in a Tertiary General Hospital in a Rapidly Developing Country

Advances in Pharmacological Sciences ◽

10.1155/2013/842593 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Ahmed Abdel-Aziz ◽

Ayman El-Menyar ◽

Hassan Al-Thani ◽

Ahmad Zarour ◽

Ashok Parchani ◽

...

Keyword(s):

Antibiotic Prophylaxis ◽

Antimicrobial Prophylaxis ◽

Surgical Units ◽

Antibiotics Use ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis ◽

Clean Contaminated ◽

Alternative Antibiotic ◽

Hospital Protocols

Objectives. To assess the standard practice of care of surgeons regarding surgical antibiotic prophylaxis, to identify gaps, and to set recommendations.Methods. A retrospective analysis of data obtained from different surgical units in a single center in Qatar over a 3-month period in 2012. A total of 101 patients who underwent surgery and followed regimes for surgical prophylaxis as per hospital guidelines were included in the study.Results. The overall use of antibiotic was 89%, whereas the current practice did not match the recommended hospital protocols in 53.5% of cases. Prolonged antibiotics use (59.3%) was the commonest reason for nonadherence followed by the use of an alternative antibiotic to that recommended in the protocol (31.5%) and no prophylaxis was used in 9.2% of cases. The rate of compliance was significantly higher among clean surgery than clean contaminated group (P=0.03). Forty-four percent of clean and 65% of clean-contaminated procedures showed noncompliance with the recommended surgical antimicrobial prophylaxis hospital guidelines.Conclusion. Lack of adherence to hospital protocols is not uncommon. This finding remains a challenge to encourage clinicians to follow hospital guidelines appropriately and to consistently apply the surgical antibiotic prophylaxis. The role of clinical pharmacist may facilitate this process across all surgical disciplines.

Download Full-text