Evaluation of prophylactic antibiotic administration in general surgery division of a teaching hospital in north of Iran

Introduction Surgical site infection (SSI) is one of the most important complications after surgeries. Depending on the type of surgery, rate of SSIs occurrence is different between 1 to 5%. This can cause prolong hospitalization and increase in morbidity and cost. To reduce the incidence of wound infection complication, prophylactic antibiotics are administered before, during and after surgical operations (1). Some studies have shown that inappropriate selection or dosing of the antimicrobial agents and excessive duration of antibiotic usage can develop antimicrobial resistance or serious adverse reactions and prolong hospitalization (2-4). Antibiotic resistance has been described as an increasing threat to global public health by the World Health Organization (WHO) because there are now few and, in some cases, no antibiotics available to treat certain life threatening infections (5). To choose a proper prophylactic antibiotic regimen, different guidelines have been developed (6). These guidelines help clinicians to make right decision in selecting, timing, dosing and duration of antimicrobial prophylaxis. There is some patient and operation associated risk factors which may affect the incidence of SSIs. Patient related factors include: age, nutritional status, diabetes, smoking, obesity, coexisting infections at distal body Abstract Surgical site infections are one of the most important post-surgery complications. Antimicrobial prophylaxis has been used routinely in surgeries to reduce infection incidence. However, inappropriate selection of antimicrobial agents or dosing can develop antimicrobial resistance, serious adverse reactions and prolong hospitalization. Current study aimed to examine prophylactic antibiotic prescription in surgeries in a teaching hospital in Sari, Mazandaran and evaluate level of adherence to the international guidelines. Between January 2015 to May 2015, 104 patients in general surgery ward were selected and enrolled in the study. The prophylactic antibiotics, dosage, timing and duration of administration were collected by reviewing patients’ records and compared to the existing guidelines. Prophylactic antibiotic was given to 85.5% of patients. Prescribed antibiotics were cefazolin (46.1%), metronidazole (24%), ceftriaxone (12.5%), ciprofloxacin (1.9%) and vancomycin (0.96%). Most of the patients (62.9%) received an inappropriate and delayed timing. Proper antibiotic dosage was seen in 45.2% of patients. All patients received post-operative prophylactic antibiotic. Main antibiotics include cefazolin (41.3%), metronidazole (33.7%), ceftriaxone (31.7%) and clindamycin (20.2%). Only 10 (21.9%) patients received cefazolin or vancomycin for a total duration of 48 hours or less. Surgical wound infection occurred in 17 (16.3%) patients during hospital stay. Adherence to antimicrobial prophylaxis guidelines was completely achieved in 14.4% of cases. Results of this study signified that adherence to existing guidelines was poor and the most common mistakes were over usage, inappropriate dosage and choosing of antibiotics.