Antibiotic Use Pattern of Surgical Site Infection Prophylaxis in Surgical Wards of a Teaching Hospital in Shiraz, Iran

Document Type : Brief Report

Authors

Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Despite the need to use prophylactic antimicrobials to prevent infection at the surgical site, in many cases the use of prophylactic antibiotics is inappropriate. The aim of this study was to determine the pattern use of surgical site infection antibiotics prophylaxis based on standard guidelines in a teaching hospital in Shiraz. In this observational study, information of 338 patients from May to October 2020 received prophylactic antibiotics before surgery at Shahid Faghihi Hospital affiliated to Shiraz University of Medical Sciences was reviewed. Type of antibiotics, combination of antibiotics, dose and duration of treatment for each patient were defined based on both the American Society of Health-System Pharmacists (ASHP) and the National Ministry of Health and Medical Education of Iran guidelines for antimicrobial prophylaxis in surgery. Of the total 338 patients included in this study, only 27.5% received antibiotic prophylaxis according to standard guidelines. The most commonly used antibiotic class for surgical site infection prophylaxis was the first generation cephalosporins. The highest rate of antibiotic prophylaxis appropriateness was identified in the urology ward (11.53%). Few cases of antibiotic prophylaxis have shown complete compliance with the standard guidelines in this preliminary report.  

Keywords

References

1.    Shabanian A, Karimi Nasab M, Shayesteh Azar M, Esmaeilnezhad Ganji S. Type and Rate of Prophylactic Antibiotic Use in the Orthopedic Patients Underwent Elective Surgeries in Shahid Beheshti Hospital in Babol. J Babol Univ Med Sci. 2018;20(5):68-73.
2.    Lucet JC, Nicolas-Chanoine MH, Roy C, Riveros-Palacios O, Diamantis S, Le Grand J, et al. Antibiotic use: knowledge and perceptions in two university hospitals. J Antimicrob Chemother. 2011 Apr;66(4):936-40. doi: 10.1093/jac/dkq541. Epub 2011 Jan 26. PMID: 21393217.
3.    Vogtländer NP, Van Kasteren ME, Natsch S, Kullberg BJ, Hekster YA, Van Der Meer JW. Improving the process of antibiotic therapy in daily practice: interventions to optimize timing, dosage adjustment to renal function, and switch therapy. Arch Intern Med. 2004 Jun 14;164(11):1206-12. doi: 10.1001/archinte.164.11.1206. PMID: 15197046.
4.    Tefera GM, Feyisa BB, Taye GM, Tesfaye Umeta G, Negash Bereded F, Dinsa Ayeno H, Alemayehu Gadisa D, Melaku Kebede T. The Association Between Incorrect Use of Antibiotic Prophylaxis and in-Hospital Surgical Site Infections - A Prospective Observational Study. Infect Drug Resist. 2020 Sep 7;13:3063-3072. doi: 10.2147/IDR.S260238.
5.    Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008 Nov;70 Suppl 2:3-10. doi: 10.1016/S0195-6701(08)60017-1. PMID: 19022115.
6.    Menz BD, Charani E, Gordon DL, Leather AJM, Moonesinghe SR, Phillips CJ. Surgical Antibiotic Prophylaxis in an Era of Antibiotic Resistance: Common Resistant Bacteria and Wider Considerations for Practice. Infect Drug Resist. 2021 Dec 7;14:5235-5252. doi: 10.2147/IDR.S319780.
7.    Afhami S, Esmailpour BN, Boujar AN, Sayadi L. Antibiotic Prophylaxis before Surgeries. Iran J Surg. 2011;19(3):28-32 [In Persian]. 
8.    Solomon DH, Van Houten L, Glynn RJ, Baden L, Curtis K, Schrager H, Avorn J. Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center. Arch Intern Med. 2001 Aug 13-27;161(15):1897-902. doi: 10.1001/archinte.161.15.1897. PMID: 11493132.
9.    Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD003543. doi: 10.1002/14651858.CD003543.pub3. Update in: Cochrane Database Syst Rev. 2017 Feb 09;2:CD003543. PMID: 23633313.
10.    Al-Momany NH, Al-Bakri AG, Makahleh ZM, Wazaify MM. Adherence to international antimicrobial prophylaxis guidelines in cardiac surgery: a Jordanian study demonstrates need for quality improvement. J Manag Care Pharm. 2009 Apr;15(3):262-71. doi: 10.18553/jmcp.2009.15.3.262. PMID: 19326957.
11.    Rosario MO, Peña AC, Ampil IDE. Adherence to surgical antimicrobial prophylaxis guidelines in a tertiary private medical center. Phil J Microbiol Infect Dis. 2010;39:51-8.
12.    Parulekar L, Soman R, Singhal T, Rodrigues C, Dastur FD, Mehta A. How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study. Indian J Surg. 2009 Feb;71(1):15-8. doi: 10.1007/s12262-009-0004-9. Epub 2009 Mar 13. PMID: 23133102; PMCID: PMC3452567.
13.    Ebrahimzadeh A, Najafi M, Bijari B, Amouzeshi A, Abedini MR, Mosavi T, Pagheh AS. The compliance of surgical prophylactic antibiotics with standard protocols in Imam Reza teaching hospital of Birjand, Iran. Iran J Microbiol. 2021 Dec;13(6):801-807. doi: 10.18502/ijm.v13i6.8082. PMID: 35222858
14.    Bailly P, Lallemand S, Thouverez M, Talon D. Multicentre study on the appropriateness of surgical antibiotic prophylaxis. J Hosp Infect. 2001 Oct;49(2):135-8. doi: 10.1053/jhin.2001.1064. PMID: 11567560.
15.    Bedouch P, Labarère J, Chirpaz E, Allenet B, Lepape A, Fourny M, et al. Compliance with guidelines on antibiotic prophylaxis in total hip replacement surgery: results of a retrospective study of 416 patients in a teaching hospital. Infect Control Hosp Epidemiol. 2004 Apr;25(4):302-7. doi: 10.1086/502396. PMID: 15108727.
16.    Thomas M, Govil S, Moses BV, Joseph A. Monitoring of antibiotic use in a primary and tertiary care hospital. J Clin Epidemiol. 
1996 Feb;49(2):251-4. doi: 10.1016/0895-4356(95)00520-x. PMID: 8606327.
17.    Hatam N, Askarian M, Moravveji AR, Assadian O. Economic burden of inappropriate antibiotic use for prophylactic purpose in shiraz, iran. Iran Red Crescent Med J. 2011 Apr;13(4):234-8. Epub 2011 Apr 1. PMID: 22737471; PMCID: PMC3371955.
18.    Askarian M, Reza Moravveji A, Assadian O. Prescription of prophylactic antibiotics for neurosurgical procedures in teaching hospitals in Iran. Am J Infect Control. 2007 May;35(4):260-2. doi: 10.1016/j.ajic.2006.04.214. PMID: 17482997.
19.    Nabavizadeh MR, Sahebi S, Nadian I. Antibiotic prescription for endodontic treatment: general dentist knowledge + practice in shiraz. Iran Endod J. 2011 Spring;6(2):54-9. Epub 2011 May 15. PMID: 23130054; PMCID: PMC3487514.
20.    Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
21.    Raeeszadeh M, Berenjian S. Prescription of Antibiotics Before and After Surgery at the Surgical Wards of Isfahan Amiralmomenin Hospital Compliance with the Standard Guidelines. Health Res J.2016;1(1):133-40.
22.    van Disseldorp J, Slingenberg EJ, Matute A, Delgado E, Hak E, Hoepelman IM. Application of guidelines on preoperative antibiotic prophylaxis in León, Nicaragua. Neth J Med. 2006 Dec;64(11):411-6. PMID: 17179571.
23.    Vessal G, Namazi S, Davarpanah MA, Foroughinia F. Evaluation of prophylactic antibiotic administration at the surgical ward of a major referral hospital, Islamic Republic of Iran. East Mediterr Health J. 2011 Aug;17(8):663-8. PMID: 21977569.
24.    Montazeri M, Shayeste SH, Haddadi A Survey of Antibiotic Prophylaxis Administered Before Surgery in a Teaching Hospital in Tehran 2014. Iran. J Infect Dis Trop Med. 2017; 21(75): 37-42 [In Persian]. 
25.    Bull AL, Russo PL, Friedman ND, Bennett NJ, Boardman CJ, Richards MJ. Compliance with surgical antibiotic prophylaxis--reporting from a statewide surveillance programme in Victoria, Australia. J Hosp Infect. 2006 Jun;63(2):140-7. doi: 10.1016/j.jhin.2006.01.018. Epub 2006 Apr 18. PMID: 16621135.
26.    Yeap JS, Lim JW, Vergis M, Au Yeung PS, Chiu CK, Singh H. Prophylactic antibiotics in orthopaedic surgery: guidelines and practice. Med J Malaysia. 2006 Jun;61(2):181-8. PMID: 16898309.
27.    Giri BR, Pant HP, Shankar PR, Sreeramareddy CT, Sen PK. Surgical site infection and antibiotics use pattern in a tertiary care hospital in Nepal. J Pak Med Assoc. 2008 Mar;58(3):148-51. PMID: 18517124. 
Trends in Pharmaceutical Sciences
Volume 9, Issue 1
March 2023
Pages 87-92

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