Antibiotic Prescription Trends & Adherence to Guideline in Surgeries Conducted in a Tertiary Hospital in Male’ (IGMH)
DOI:
https://doi.org/10.62338/dxadwz60Keywords:
Appendectomy, Cholecystectomy, Hernia Repair, Adherence, Antibiotic Prophylaxis, Treatment Guidelines, Adherence to GuidelinesAbstract
Infections from surgical sites are a global health concern. Even while surgical site infections may be avoided, they nonetheless have a substantial negative impact on patient outcomes, national budgets, and mortality rates. Inappropriate uses of surgical antimicrobial prophylaxis are increasing and worsening patients’ quality of life. The evidence-based practice of using antibiotics prophylactically prior to surgery aims to avoid surgical site infections (SSIs). The aim of the study is to investigate the adherence to antibiotic guidelines. A retrospective observational research was done at IGMH during 2022-2023 utilizing a structured data abstraction methodology. The study included patients who underwent three surgeries: appendectomy, cholecystectomy, and hernia repair. Data were gathered from January to March 2024. A census sample method was used to choose 476 surgical cases. SPSS version 23.0 was used to perform descriptive statistics and chi-square analysis. The findings reported a total of 476 eligible surgical cases. Hernia repairs made up 42.9% of the cases, followed by cholecystectomy (33.3%) and appendectomy (23.8%). A significant portion of appendectomies (87.7%) were emergency surgeries. Surgical Antimicrobial Prophylaxis was prescribed in 456 patients (95.20%). Out of this, appropriate antibiotics according to evidence-based guidelines were given to only 244 (53.51%) patients, from which only 3 (1.23%) received the right dose according to the evidence based guideline. The route of administration was correct and according to recommendations. The timing of Surgical Antimicrobial Prophylaxis (SAP) was according to guidelines in 56.80% of patients (within 1 hour before surgical incision). Out of the patients for whom SAP was recommended, all received prophylaxis and out of those who had no indication, none received prophylaxis. Most patients received ceftriaxone (75.60%) as prophylactic antibiotic. Our study also found a statistically significant relationship between age, gender, type of surgery and elective and emergency surgeries with adherence to evidence based guidelines. We found poor treatment adherence to antibiotic prophylaxis guidelines regarding different types of surgeries. This study highlights the importance of implementing standardized antibiotic prescribing guidelines in the Maldives.
References
Alahmadi, Y. M., Alharbi, R. H., Aljabri, A. K., Alofi, F. S., Alshaalani, O. A., & Alssdi, B. H. (2020). Adherence to the guidelines for surgical antimicrobial prophylaxis in a Saudi tertiary care hospital. Journal of Taibah University Medical Sciences, 15(2), 136–141. https://doi.org/10.1016/j.jtumed.2020.01.005
Andersen, B. R., Kallehave, F. L., & Andersen, H. K. (2005). Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database of Systematic Reviews, 2009(1), CD001439. https://doi.org/10.1002/14651858.CD001439.pub2
Aufenacker, T. J., Koelemay, M. J. W., Gouma, D. J., & Simons, M. P. (2006). Effectiveness of antibiotic prophylaxis in preventing wound infection after mesh repair of abdominal wall hernia: A systematic review and meta-analysis. British Journal of Surgery, 93(1), 5–10. https://doi.org/10.1002/bjs.5186
Birindelli, A., Sartelli, M., Di Saverio, S., Coccolini, F., Ansaloni, L., van Ramshorst, G. H., Campanelli, G., Khokha, V., Moore, E. E., Peitzman, A., Velmahos, G., Moore, F. A., … Catena, F. (2017). 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World Journal of Emergency Surgery, 12(1), Article 37. https://doi.org/10.1186/s13017-017-0149-y
Bratzler, D. W., Dellinger, E. P., Olsen, K. M., Perl, T. M., Auwaerter, P. G., Bolon, M. K., Fish, D. N., Napolitano, L. M., Sawyer, R. G., Slain, D., Steinberg, J. P., Weinstein, R. A., American Society of Health-System Pharmacists, Infectious Disease Society of America, Surgical Infection Society, & Society for Healthcare Epidemiology of America. (2013). Clinical practice guidelines for antimicrobial prophylaxis in surgery. *American Journal of Health-System Pharmacy, 70*(3), 195–283. https://doi.org/10.2146/ajhp120568
Cantas, L., Shah, S. Q., Cavaco, L. M., Manaia, C. M., Walsh, F., Popowska, M., Garelick, H., Bürgmann, H., & Sørum, H. (2013). A brief multi-disciplinary review on antimicrobial resistance in medicine and its linkage to the global environmental microbiota. Frontiers in Microbiology, 4, 96. https://doi.org/10.3389/fmicb.2013.00096
Cantón, R., Akova, M., Langfeld, K., & Torumkuney, D. (2022). Relevance of the consensus principles for appropriate antibiotic prescribing in 2022. Journal of Antimicrobial Chemotherapy, 77(Suppl 1), i2–i9. https://doi.org/10.1093/jac/dkac211
Centers for Disease Control and Prevention. (2020). Antibiotic use in the United States, 2020 update: Progress and opportunities. https://archive.cdc.gov/www_cdc_gov/antibiotic-use/stewardship-report/2020.html
Charani, E., Ahmad, R., Rawson, T. M., Castro-Sanchèz, E., Tarrant, C., & Holmes, A. H. (2019). Differences in antibiotic decision-making between acute surgical and medical teams: An ethnographic study. Clinical Infectious Diseases, 69(1), 12–20. https://doi.org/10.1093/cid/ciy844
Charani, E., de Barra, E., Rawson, T. M., Gill, D., Gilchrist, M., Naylor, N. R., & Holmes, A. H. (2019). Antibiotic prescribing in general medical and surgical specialties: A prospective cohort study. Antimicrobial Resistance & Infection Control, 8(1), Article 151. https://doi.org/10.1186/s13756-019-0603-6
Dylis, A., Boureau, A. S., Coutant, A., Batard, E., Javaudin, F., Berrut, G., de Decker, L., & Chapelet, G. (2019). Antibiotics prescription and guidelines adherence in elderly: Impact of the comorbidities. BMC Geriatrics, 19, Article 291. https://doi.org/10.1186/s12877-019-1265-1
Giordano, M., Squillace, L., & Pavia, M. (2017). Appropriateness of surgical antibiotic prophylaxis in pediatric patients in Italy. Infection Control & Hospital Epidemiology, 38(7), 823–831. https://doi.org/10.1017/ice.2017.79
Gouvêa, M., Novaes, C. de O., Pereira, D. M. T., & Iglesias, A. C. (2015). Adherence to guidelines for surgical antibiotic prophylaxis: A review. The Brazilian Journal of Infectious Diseases, 19(5), 517–524. https://doi.org/10.1016/j.bjid.2015.06.004
Gul, Y. A., Hong, L. C., & Prasannan, S. (2005). Appropriate antibiotic administration in elective surgical procedures: Still missing the message. Asian Journal of Surgery, 28(2), 104–108. https://doi.org/10.1016/S1015-9584(09)60272-8
Ierano, C., Nankervis, J. M., James, R., Rajkhowa, A., Peel, T., & Thursky, K. (2017). Surgical antimicrobial prophylaxis. Australian Prescriber, 40(6), 225–229. https://doi.org/10.18773/austprescr.2017.073
Khan, Z., Ahmed, N., Zafar, S., ur Rehman, A., Khan, F. U., Saqlain, M., Kamran, S., & Rahman, H. (2020). Audit of antibiotic prophylaxis and adherence of surgeons to standard guidelines in common abdominal surgical procedures. Eastern Mediterranean Health Journal, 26(9), 1052–1061. https://doi.org/10.26719/emhj.20.025
Körner, H., Söndenaa, K., Söreide, J. A., Andersen, E., Nysted, A., Lende, T. H., & Kjellevold, K. H. (1997). Incidence of acute nonperforated and perforated appendicitis: Age-specific and sex-specific analysis. World Journal of Surgery, 21(3), 313–317. https://doi.org/10.1007/s002689900235
Lamb, G., Phillips, G., Charani, E., Holmes, A., & Satta, G. (2021). Antibiotic prescribing practices in general surgery: A mixed methods quality improvement project. Infection Prevention in Practice, 3(3), 100166. https://doi.org/10.1016/j.infpip.2021.100166
Laxminarayan, R., Duse, A., Wattal, C., Zaidi, A. K. M., Wertheim, H. F. L., Sumpradit, N., Vlieghe, E., Hara, G. L., Gould, I. M., Goossens, H., Greko, C., So, A. D., Bigdeli, M., Tomson, G., Woodhouse, W., Ombaka, E., Peralta, A. Q., Qamar, F. N., Mir, F., … Cars, O. (2013). Antibiotic resistance—the need for global solutions. The Lancet Infectious Diseases, 13(12), 1057–1098. https://doi.org/10.1016/S1473-3099(13)70318-9
Moges, G., Belete, L., Mengesha, Y., & Ahmed, S. (2020). Evaluation of surgical antimicrobial prophylaxis and incidence of surgical site infection at Borumeda Hospital, Northeast Ethiopia: A retrospective cross-sectional study. Drug, Healthcare and Patient Safety, 12, 257–268. https://doi.org/10.2147/DHPS.S280442
Moris, D., Paulson, E. K., & Pappas, T. N. (2021). Diagnosis and management of acute appendicitis in adults. JAMA, 326(22), 2299–2300. https://doi.org/10.1001/jama.2021.20502
Mugada, V., Mahato, V., Andhavaram, D., & Vajhala, S. M. (2021). Evaluation of prescribing patterns of antibiotics using selected indicators for antimicrobial use in hospitals and the AWaRe classification. Turkish Journal of Pharmaceutical Sciences, 18(3), 282–288. https://doi.org/10.4274/tjps.galenos.2020.11456
Nabor, M. I. P., Buckley, B. S., & Lapitan, M. C. M. (2015). Compliance with international guidelines on antibiotic prophylaxis for elective surgeries at a tertiary-level hospital in the Philippines. Healthcare Infection, 20(3–4), 145–151. https://doi.org/10.1071/hi15018
Naylor, N. R., Evans, S., Pouwels, K. B., Troughton, R., Lamagni, T., Muller-Pebody, B., Knight, G. M., Atun, R., & Robotham, J. V. (2022). Quantifying the primary and secondary effects of antimicrobial resistance on surgery patients: Methods and data sources for empirical estimation in England. Frontiers in Public Health, 10, 803943. https://doi.org/10.3389/fpubh.2022.803943
Ng, R. S. (2012). Surgeons’ adherence to guidelines for surgical antimicrobial prophylaxis: A review. Australasian Medical Journal, 5(10), 534–540. https://doi.org/10.4066/amj.2012.1312
Parulekar, L., Soman, R., Singhal, T., Rodrigues, C., Dastur, F. D., & Mehta, A. (2009). Compliance with surgical antibiotic prophylaxis guidelines in a tertiary care hospital in India: A prospective study. Indian Journal of Surgery, 71(1), 15–18. https://doi.org/10.1007/s12262-009-0004-9
Pereira, L. B., Feliciano, C. S., Bellissimo-Rodrigues, F., & Pereira, L. R. L. (2024). Evaluation of adherence to surgical antibiotic prophylaxis recommendations and associated factors in a university hospital: A cross-sectional study. American Journal of Infection Control, 52(11), 1320–1328. https://doi.org/10.1016/j.ajic.2024.07.004
Saleem, Z., Hassali, M. A., Versporten, A., Godman, B., Hashmi, F. K., Goossens, H., & Saleem, F. (2019). A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: Findings and implications. *Expert Review of Anti-infective Therapy, 17*(4), 285–293. https://doi.org/10.1080/14787210.2019.1581063
Schmitt, C., Lacerda, R. A., Padoveze, M. C., & Turrini, R. N. T. (2012). Applying validated quality indicators to surgical antibiotic prophylaxis in a Brazilian hospital. American Journal of Infection Control, 40(10), 960–962. https://doi.org/10.1016/j.ajic.2012.01.016
Tadesse, T. Y., Molla, M., Yimer, Y. S., Tarekegn, B. S., & Kefale, B. (2022). Evaluation of antibiotic prescribing patterns among inpatients using World Health Organization indicators: A cross-sectional study. SAGE Open Medicine, 10, 205031212210966. https://doi.org/10.1177/20503121221096608
Talan, D. A., & Di Saverio, S. (2021). Treatment of acute uncomplicated appendicitis. New England Journal of Medicine, 385(12), 1116–1123. https://doi.org/10.1056/nejmcp2107675
Tourmousoglou, C. E., Yiannakopoulou, E. C., Kalapothaki, V., Bramis, J., & Papadopoulos, J. S. (2007). Adherence to guidelines for antibiotic prophylaxis in general surgery: A critical appraisal. Journal of Antimicrobial Chemotherapy, 61(1), 214–218. https://doi.org/10.1093/jac/dkm406
Trikha, S., Dalpath, S., Sharma, M., & Shafiq, N. (2020). Antibiotic prescribing patterns and knowledge of antibiotic resistance among doctors in northern India: A cross-sectional study. Journal of Family Medicine and Primary Care, 9(8), 3937. https://doi.org/10.4103/jfmpc.jfmpc_367_20
van Kasteren, M. E. E. (2003). Adherence to local hospital guidelines for surgical antimicrobial prophylaxis: A multicentre audit in Dutch hospitals. Journal of Antimicrobial Chemotherapy, 51(6), 1389–1396. https://doi.org/10.1093/jac/dkg264
World Health Organization. (2018). How to investigate antimicrobial use in hospitals: Selected indicators. Journal of Applied Pharmaceutical Science, 8(6), 132–138. https://doi.org/10.7324/japs.2018.8617
Wu, P., Chou, C. K., Hsieh, Y. C., Chen, C. K., Lin, Y. T., Huang, Y. H., Hou, M., Lin, H. C., & Lee, K. C. (2020). Antibiotic use in patients with acute cholecystitis after percutaneous cholecystostomy. Journal of the Chinese Medical Association, 83(2), 163–168. https://doi.org/10.1097/jcma.0000000000000244
