Surgical Site Infection and its Relation with Prophylactic Antibiotics Prescription Pattern in a Tertiary Care Hospital of North India

ABSTRACT

Background: Contribution of antibiotic prophylaxis in reducing surgical site infection for some procedures is well known. In spite of knowledge about the effectiveness of antibiotic prophylaxis, its administrative regimens are often inappropriate. Objectives: To study the pattern of use of preoperative prophylactic antibiotic and its relationship with surgical site infection (SSI) in a tertiary care teaching Hospital. Methods Hundred case records files of patients admitted in surgical wards of Jawaharlal Nehru Medical College, Aligarh who had undergone open bowel surgery, were randomly selected from the Central Record Section and analyzed for prescription pattern for prophylactic antibiotics according to World Health Organization prescribing indicators for number of antibiotics, antibiotics prescribed by generic name and antibiotics prescribed from ‘Essential Medicines’ List per encounter. Cost of antibiotics, commonly prescribed antibiotics and timing of administration were also studied. Patients who developed surgical site infection and those who did not were compared statistically. Results: Commonly administered antibiotics were Ceftriaxone, Metronidazole and Amikacin given intravenously just before surgery. No relationship was seen between patient’s age, type of surgery or site of disease and choice of antibiotics. No drug was prescribed by generic name. Total cost on antibiotics was Indian Rupees 73.1 to 218.0. Surgical site infection developed in 40 patients. No significant relationship found between administration of any antibiotics or their cost and development of surgical site infection. High degree of resistance to Fluoroquinolones followed by second and third generation Cephalosporins was found in infecting organisms. Conclusions: Prescribing pattern was not based on World Health Organization criteria for rational use of drugs and not evidence based. This study indicates the need for interventions to improve rational use of antibiotic prophylaxis in India.