A study on the antimicrobial usage pattern for the prevention of surgical site infections in a teaching hospital


  • Rajkumar K. Department of General Surgery, Amala Institute of Medical Sciences, Thrissur, Kerala, India




Antibiotic usage pattern, Prophylaxis, Surgical site infection


Background: Wrong antimicrobial selection and usage increase the incidence of drug resistance, drug toxicity and superinfections, thus decreasing the quality of healthcare delivery. Various approaches for rationalizing the antimicrobial usage have been recommended. Understanding the existing antimicrobial usage pattern is suggested as the first step in this approach, which would help to understand the current issues and to find the solution. The aim of the study was to evaluate the usage pattern of antimicrobial prophylaxis in surgical patients, to identify any inappropriateness of the usage.

Methods: A retrospective evaluation of the randomly selected 258 medical records of general surgical cases for eight months in a tertiary care teaching hospital were verified for the appropriateness of the antimicrobial prophylaxis. The collected data was studied, and conclusions were drawn with the help of appropriate statistics.

Results: All the 262 (100%) patients received a third generation cephalosporin through the intravenous route as a prophylactic dose. Also, 92 (35%) patients received nitroimidazole or aminoglycosides in addition to the cephalosporins. The antimicrobials were administered half an hour to one hour before the surgery. No intraoperative redosing was given.

Conclusions: The timing of administration of the preoperative dose was at par with international guidelines and well allotted to the nursing staff. The intraoperative dose was appropriately omitted in the short term surgeries. The main concern was the increasing use of the third generation cephalosporins and the long duration of the postoperative prophylaxis, which required to be addressed.



Behnke M, Johannes Aghdassi S, Hansen S, Peña Diaz LA, Gastmeier P, Piening B. The Prevalence of Nosocomial Infection and Antibiotic Use in German Hospitals. Deutsches Aerzteblatt Int. 2017;114(50):851-7.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guide¬line for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250-78.

Campoccia D, Montanaro L, Speziale P, Arciola CR. Antibiotic-loaded biomaterials and the risks for the spread of antibiotic resistance following their prophylactic and therapeutic clinical use. Biomaterials. 2010;31(25):6363-77.

Hawn MT, Richman JS, Vick CC, Deierhoi RJ, Graham LA, Henderson WG, Itani KM. Timing of surgical antibiotic prophylaxis and the risk of surgical site infection. JAMA Surg. 2013;148(7):649-57.

Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases. 2016;62(10):51-77.

Wang J, Wang P, Wang X, Zheng Y, Xiao Y. Use and prescription of antibiotics in primary health care settings in China. JAMA Internal Med. 2014;174(12):1914-20.

Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM. Adherence to surgical care improvement project measures and the association with postoperative infections. J Am Med Assoc. 2010;303(24):2479-85.

Rehan HS, Kakkar AK, Goel S. Pattern of surgical antibiotic prophylaxis in a tertiary care teaching hospital in India. Int J Infection Control. 2010;6(2).

Ng RS, Chong CP. Surgeons' adherence to guidelines for surgical antimicrobial prophylaxis–a review. Australasian Med J. 2012;5(10):534.

De SC, Chiumello D, Nicolini R, Vigorelli M, Cesana B, Bottino N, et al. Prolongation of antibiotic prophylaxis after clean and clean-contaminated surgery and surgical site infection. Minerva Anestesiologica. 2010;76(6):413-9.

Al-Azzam SI, Alzoubi KH, Mhaidat NM, Haddadin RD, Masadeh MM, Tumah HN, et al. Preoperative antibiotic prophylaxis practice and guideline adherence in Jordan: a multi-centre study in Jordanian hospitals. J Infection Developing Countries. 2012;6(10):715-20.

Rafati M, Shiva A, Ahmadi A, Habibi O. Adherence to American society of health-system pharmacists surgical antibiotic prophylaxis guidelines in a teaching hospital. J Res Pharm Pract. 2014;3(2):62.

Afzal Khan AK, Mirshad PV, Mohammed Rafiuddin Rashed GB. A study on the usage pattern of antimicrobial agents for the prevention of surgical site infections (SSIs) in a tertiary care teaching hospital. J Clin Diagnos Res. 2013;7(4):671.

Baniasadi S, Alaeen Z, Shadmehr MB. Surgical Antibiotic Prophylaxis: A Descriptive Study among Thoracic Surgeons. Tanaffos. 2016;15(3):154.

Vakade KP, Thorat VM, Khanwelkar CC, Jadhav SA, Sanghishetti VM. A study of prescribing pattern of drugs in patients of cardiovascular emergencies at a tertiary care hospital of Western Maharashtra. Int J Res Med Sci. 2016;4(2):556-61.

Kim ES, Park SW, Lee CS, Kwak YG, Moon C, Kim BN. Impact of a national hospital evaluation program using clinical performance indicators on the use of surgical antibiotic prophylaxis in Korea. Int J Infect Dis. 2012;16(3):187-92.

Ovaska MT, Mäkinen TJ, Madanat R, Huotari K, Vahlberg T, Hirvensalo E, et al. Risk factors for deep surgical site infection following operative treatment of ankle fractures. J Bone Joint Surg Am. 2013;95(4):348-53.

Deuster S, Roten I, Muehlebach S. Implementation of treatment guidelines to support judicious use of antibiotic therapy. J Clin Pharm Therap. 2010;35(1):71-8.

Katsios CM, Burry L, Nelson S, Jivraj T, Lapinsky SE, Wax RS, et al. An antimicrobial stewardship program improves antimicrobial treatment by culture site and the quality of antimicrobial prescribing in critically ill patients. Critical care. 2012;16(6):216.






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