A single-dose antibiotic prophylaxis to prevent surgical site infection in clean-contaminated surgery
AbstractBackground: Surgical site infection (SSI) is one of the most common healthcare associated infections (HAI) with the consequences of morbidity, mortality and resource utilization. Several guidelines have recommended that antibiotic prophylaxis should be given only at premedication, except in selected cases. In our setting, poor compliance with the recommendations is observed. The aim of this study was to test the ef! cacy of single dose antibiotic prophylaxis on the occurrence of postoperative SSI in clean-contaminated surgery.Patients and methods: The study was carried out at KIST Medical College and Teaching Hospital, Lalitpur, Nepal from September 2008 to August 2012 involving 1100 patients who underwent major clean-contaminated surgery. 636 patients received 1g of ceftriaxone intravenously as prophylactic antibiotic within 30 minutes prior to incision (group 1). As reference cases, we reviewed 464 patients who received the therapeutic courses of antibiotics (group 2). Ethical approval was taken from institutional review board. All the patients were followed up for 30 postoperative days. The SSI rates were compared in two groups. Specimens were collected from the infected wounds and tested for culture and sensitivity using Kirby-Bauer disc diffusion technique. Antimicrobial susceptibility pro! le of bacterial pathogens in postoperative wound infections was studied. Data were analyzed using Statistical Package for Social Sciences (SPSS) 15. Chi square test was used in process of data analysis. Results: SSI rates in group 1 and group 2 were 44 of 636 (6.92%) and 38 of 464 (8.19%) respectively. There was no signi! cant difference in SSI rates between group 1 and group 2 (p=0.359). Among 44 patients with clinical SSI in group 1, 32 (72.73%) had positive aerobic culture. Staphylococcus aureus was the predominant organism isolated in 17/32 (53.12%) cases. It was followed by Escherichia coli isolated in 7/32(21.87%) cases. 60.31% of total isolates (including all organisms) were sensitive to ceftriaxone.Conclusion: Only single dose of ceftriaxone 1g given within 30 minutes prior to incision is suf! cient to prevent SSI in clean-contaminated cases in our setting. Rampant use of antibiotics without evidence should be discouraged.Key words: surgical site infection, antibiotic prophylaxis, compliance
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