Abstract

AN ASSESSMENT AND EVALUATION OF PRESCRIPTION PATTERN FOR SURGICAL ANTIBIOTIC PROPHYLAXIS AT TERTIARY CARE HOSPITAL-A PROSPECTIVE OBSERVATIONAL STUDY

Sayma Dhanjisha*, Pratibhakumari Rohit, Abhilasha Rathore*, Pooja Yadav, Dr. Zeel Naik and Dr. Chintan B. Patel

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Abstract

Introduction: SSIs are the third most frequent cause of nosocomial infection amongst hospitalized patients and the most common type of HAI in LMICs, which may contribute to increased antibiotic usage, associated cost, prolonged hospitalization, and patient morbidity and mortality. Therefore, SAP is an effective management strategy for reducing post-operative infections associated with appropriate selection, timing and duration. However, in actual practice, there are limited data and considerable evidence regarding compliance with existing guidelines. Significant improvement in prescribing practice (potentially attributable to antimicrobial stewardship program) in hospitals is a complementary strategy to optimize the use of antimicrobials. Objectives: The objective of this study was to assess the pre-post-operative antibiotic use and to study compliance with WHO global guideline (EML guidance on SAP final version) as well as hospital antibiotic policy (Antibiogram) at Kiran Multi super Speciality hospital and research centre, Surat. Material and methods: A hospital based prospective observational study was conducted in the surgical ward of Kiran multi super speciality hospital and research center, Surat, Gujarat, India after getting ethical clearance. A total of 150 patients of any age who underwent the various types of surgical procedures were enrolled in this study. Pre-tested Performa case report form and individual ICF form waived. Patients who undergoing haemodialysis and chemotherapy were excluded from this study. Google Excel sheet was used for data entry and Microsoft Excel software 2013 was computed for descriptive analysis. Result: Out of 150 patients, highest 35(23%) were operated for neurosurgery, and the remaining were for other types of surgeries. SAP was prescribed to 137(91%) patients, and 13(9%) were not prescribed (not indicated). Among the 150 patients, 131(87%) received a single SAP agent, and the remaining received more than one agent. Ceftriaxone as single agent, cefoperazone+sulbactam and amoxicillin+clavulanate potassium fixed dose combination, were most commonly prescribed antibiotics. In this study, 131(87%) patients received SAP within 120 minutes before surgical incision. However, in the majority of cases, antibiotics were prescribed for the appropriate duration in compliance with recommendations. Conclusion: This observational study indicates that most of the patients 137(91%) received surgical antibiotic prophylaxis. The third generation of cephalosporin particularly ceftriaxone, was the most commonly prescribed antibiotic. Since antibiotics were prescribed as per surgeons own experience and empirical methods.

Keywords: Surgical Antibiotic Prophylaxis (SAP), Antimicrobial Agents (AMAs), Surgical Site Infection (SSI), Low-middle-income countries (LMICs), Guidelines compliance, Antibiotic stewardship.