An observational study on the surgical antibiotic prophylaxis in the surgery ward of a tertiary care hospital

Background: Surgical site infection (SSI) is the most common postoperative complication and represents a significant burden in terms of patient morbidity, mortality and cost to health services around the world. Appropriate antibiotic prophylaxis helps in reducing the incidence of SSIs. Appropriate surgical prophylaxis is a multifactorial process that depends on proper case selection, antibiotic selection including dosing and route of administration and duration of therapy.Methods: A prospective observational study was conducted over 3 months on 200 operated patients in surgery ward of a tertiary hospital. Patient details like demography, type of surgery performed and antibiotics prescribed pre and post-surgical procedure was collected and analysed using Microsoft excel.Results: Out of 200 patients 32.5% (65) were females and 67.5% (135) were males. Total number of prophylactic antibiotics prescribed were 368. The most commonly prescribed group of antibiotics was cephalosporins (44.29%) followed by metronidazole (26.5%) and ofloxacin (9.48%). Among the cephalosporins the most commonly prescribed was cefuroxime in 82 patients (50.3%) and cefoperazone in 79 patients (48.46%). SSI developed in 3 out of 200 patients (1.5%).Conclusions: There is an urgent requirement to promote rational antibiotic prescribing among surgeons. The need of the hour is developing and implementing national guidelines for surgical prophylaxis by a multidisciplinary group of experts.

Caracterización de cesáreas primitivas en Santa Cruz del Norte / Characterization of Primitive Cesareans in Santa Cruz Del Norte

Introducción: la operación cesárea ha incrementado en Latinoamérica y en gran parte del mundo en los últimos años. Objetivo: establecer el comportamiento de las cesáreas primitivas en Santa Cruz del Norte en un período de 15 meses. Métodos: se realizó un estudio descriptivo transversal desde julio de 2012 hasta septiembre de 2013 con un universo de 127 pacientes sometidas a cesárea primitiva y una muestra que se hizo coincidir con el universo. Los datos se recolectaron mediante la revisión del libro de registro de nacimientos, la historia clínica obstétrica y hospitalaria. Estadísticamente se empleó la distribución de frecuencias, porcentaje, índice, prueba t de Student y chi cuadrado. Resultados: el índice de cesáreas primitivas fue elevado (34,9 por ciento) con tendencia temporal mantenida, sobre todo por meconio anteparto con malas condiciones obstétricas (29,9 por ciento), estado fetal intranquilizante (14,2 por ciento) y desproporción céfalo-pélvica (14,2 por ciento). La clasificación de la cesárea fue incorrecta en 59,8 por ciento, así como la profilaxis con antimicrobianos en 74,8 por ciento. Las complicaciones neonatales más frecuentes fueron el distrés respiratorio (8,7 por ciento) y la asfixia perinatal (6,3 por ciento); y en las puérperas el sangramiento postparto (10,2 por ciento) y la endometritis (8,7 por ciento). Conclusiones: se evidenció un elevado índice de cesáreas primitivas, muchas de ellas con indicaciones injustificadas y un mal manejo de la clasificación y profilaxis quirúrgica que conllevó a complicaciones neonatales y puerperales(AU)

Introduction: The cesarean section has increased in great scale in Latin America and all over the world in the last years. Objective: Establish the actual state of cesarean section in Santa Cruz del Norte in a period of 15 months. Methods: a cross section study was conducted from July 2012 to September 2013 in a universe of 127 patients with cesarean section for the first time; the whole universe was intentionally selected to compose the sample. The data were collected by the review of book of births, clinical and obstetric records and they were processed using frequency distribution, percentage, rate, Student's test and Ji-square. Results: The cesarean section rate was elevated (34,9 percent) keeping the same temporal tendency, mostly due to antepartum meconium with poor cervix conditions (29,9 percent), non-reassuring fetal status (14,2 percent) and cephalo-pelvic disproportion (14,2 percent ). 59,8 percent had incorrect cesarean classification and prophylaxis with antibiotics was mainly incorrect in 74,8 percent. Respiratory distress (8,7 percent) and perinatal asphyxia (6,3 percent) were the most frequently neonatal complications, whereas postpartum hemorrhage (10,2 percent) and endometritis (8,7 percent) were the most frequently in mothers. Conclusions: High rate of cesarean sections was found, most of them with unjustified indications and a wrong management of the classification and surgical prophylaxis leading to neonatal and maternal complications(AU)

Presurgical Antibiotic Prophylaxis Pattern In An Indian Tertiary Care Teaching Hospital.

The present study was performed to study the antibiotic prophylaxis pattern in patients admitted in Surgery and Obstetrics and Gynaecology wards of a Tertiary Care Teaching hospital in North India. It was an observational, non interventional and analytical study used to evaluate the patients undergoing surgery through period of one and half years. Information concerning demographic data, type of surgery, and parameters of antibiotic therapy (selection of antibiotic, dose, route and duration of therapy as well as cost) was collected from case records of 400 patients. Third generation cephalosporins were the most commonly prescribed class of antibiotics. No consistency was noted in the timing of administration of prophylactic antimicrobials agents which were prescribed 30 minutes to 6 hours before surgery. The dose was not repeated during surgery. Majority of antibiotics were prescribed from Essential Medicines List. Surgical prophylaxis was inappropriate in terms of choice of antimicrobial agent, timing of administration as well as the total duration of prescription, in majority of the cases. Interventions are warranted to promote the development, dissemination and adoption of evidence based guidelines for antimicrobial prophylaxis.

Avaliação do uso de cefazolina como profilaxia antibiótica em procedimentos cirúrgicos / Evaluation of cephazolin use as surgical-site infection prophylaxis in Hospital de Clínicas de Porto

Introdução: Infecções cirúrgicas são o segundo tipo mais frequente de infecção relacionada à assistência de saúde e tem sua incidência reduzida com a administração de antibioticoprofilaxia cirúrgica. Materiais e métodos: Foi realizado estudo transversal, de 01 de março a 30 de abril de 2010, observando-se a adequação do uso da cefazolina na profilaxia cirúrgica. A adequação foi avaliada conforme: 1. O tempo da primeira dose, 2. A dose utilizada, 3. Doses adicionais durante a cirurgia e 4. O tempo de manutenção do antimicrobiano após o procedimento. Resultados: Foram avaliadas 264 cirurgias com uso de cefazolina como antibioticoprofilaxia cirúrgica. Cirurgias limpas foram 85,6% da amostra, dessas 43,4% tinham implante de prótese. Todas as quatro etapas avaliadas estavam adequadas em 33,7% das cirurgias, e todas as etapas foram inadequadas em 2,3% das cirurgias. O tempo para a primeira dose estava correto em 66,3% dos procedimentos. Apenas um paciente teve administrada dose inadequada do antibiótico. Das cirurgias com mais de 3h de duração, em 46,5% foram realizadas doses adicionais da cefazolina. Quarenta e oito por cento dos pacientes receberam o antimicrobiano por mais de 24h. Em 6,1% destes pacientes foi feito o diagnóstico de infecção associada ao procedimento cirúrgico. Conclusão: Há uma baixa taxa de adequação da profilaxia cirúrgica com cefazolina no hospital. É necessária uma padronização desta profilaxia, com a instituição de um protocolo assistencial visando uniformizar as condutas para a prevenção da infecção de sítio cirúrgico no HCPA.

Aims: Surgical site infections are the second most frequent cause of healthcare associated infections, and their incidence is reduced with the administration of antimicrobial prophylaxis. Methods: This cross-sectional study, conducted from March 1 to April 30, 2010, evaluated adequacy and timeliness of cefazolin administration as surgical prophylaxis. Adequacy parameters were: (1) time to first dose; (2) cefazolin dose infused; (3) additional dose during surgery; and (4) duration of antimicrobial therapy after surgery. Results: Of a total of 264 surgeries evaluated, 85.6% were classified as clean, and prostheses were implanted in 43.4%. All steps of antimicrobial prophylaxis were adequate in 33.7% of the surgeries, and all steps were inadequate in 2.3%. Time to first dose was correct in 66.3% of the cases. Only one patient received an inadequate dose of the antimicrobial. Additional doses of cefazolin were administered in 46.5% of the surgeries that lasted more than 3 hours, and 48% of the patients received antimicrobial therapy for more than 24 hours. Surgical site infection was diagnosed in 6.1% of the patients. Conclusion: The rate of adequacy of surgical prophylaxis in the hospital was low. Standardized protocols and practices should be established to ensure adequate prevention of surgical site Infection in hospitals.

Surgical Site Infection / 한양의대학술지

Surgical site infections (SSI) are the third most important cause of iatrogenic infection in the hospital setting. SSI is known to be preventable in up to 35% of cases if active infection control procedures are implemented. Although there have been significant improvements in prevention of SSI due to changes in the operating environment, surgical techniques, and surgical prophylaxis, it is hard to avoid surgical site infection completely. Therefore, the effective prevention of SSI continues to include surveillance and feedback to surgeons. Herein, a clear standard for defining and reporting of SSI is provided, and current knowledge concerning the epidemiology, risk factors, prevention and treatment of SSI is reviewed.