A Study on Role of Antimicrobials in General Surgery
Dr. M.Senthil Velan1, Dr. Asayas Bosco Chandra Kumar*2, Dr.Abirami3, Dr.Agila4
1,2, 3,4Deptartment of General Surgery, Sri Lakshmi Narayana institute of Medical Sciences, Osudu, Agaram village, Pondicherry-605502
*Corresponding Authors
Dr. Asayas Bosco Chandra Kumar Dept. of general surgery
Sri Lakshmi Narayana institute of Medical Sciences Osudu, Agaram village,
Pondicherry-605502
[email protected] Abstract:
Background: A study on prophylactic use of antibiotics to prevent infection and to determine the indication extent and appropriateness of use of prophylactic antibiotics
Methods:
A four point prevalence study was conducted in which the patients were screened for the use of prophylactic antibiotics.
Results:
Of 500 antibiotics prescriptions 150 antibiotics were given as prophylaxis and adherence to protocolwasseenin 140 cases
Conclusion:
Antibiotics prophylaxis given outside the operating room accounts for a considerable pat of in - hospital use of antibiotics. All the prescriptions given were strictly adherent to the protocol.
Keywords: antibiotics, prophylaxis, point prevalence study Introduction
Antibiotic prophylaxis accounts for a significant amount of antibiotics used. Pre- operative antibiotics prevents upto 80% of surgical site infections. Increase in the need of invasive therapies has increased the indication for antibiotic prophylaxis for prevention of infection. Lack of clinical trials has led to different interpretations on dosage and duration of antibiotic prophylaxis leading to its suboptimal use. Studies have also shown that there is a lack of knowledge regarding the extent,indication and evidence of antibiotic prophylaxis. In this study a point prevalence study was carried out to establish the role of prophylactic antibiotics. And the goal was to investigate the extent of prophylaxis, indications for prophylaxis, and adherence to protocol
Material And Methods
This study was carried out on May 2018 in Sri Lakshmi Narayana institute of medical sciences,a tertiary care hospital at Puducherry. The surgery department performs complex
surgeries and an antibiotic stewardship team is present to monitor the use of antibiotics and the adherence to the protocol this study was done to improve the quality and the patients data was entered anonymously. So,the medical ethics committee approval was not required.
Results
Out of 500 antibiotics prescriptions 150 antimicrobial prescriptions were given as prophylaxis.in about 140 antibiotics prescriptions there was strict adherence to protocol. In 10 cases, antibiotics were prescribed without any adherence to protocol.
Discussion
This study was done to find out the extent, indication and appropriateness of antibiotic prophylaxis that was given outside the operating room in a tertiary care hospital. About one-third of all the antibiotic used was for prophylaxis. There was strict adherence to protocol for all the antibiotics used.The high adherence rate to protocol for the use of antibiotics may be because of the fact that prophylaxis is more easily protocolized than therapy.
The strength of this study is that it was done at four different time points, and the prescription was manually identified and validated by a computerized medication order system.Limitations of this study is that some indications are missed and documentation of indication is also not done at many instances.Additional disadvantage is that this study did not include outpatients in whom prophylactic antibiotics are initiated.
Data collection:
Point prevalence study:
Four-point prevalence study was performed on four consecutive Wednesdays, to determine the role of prophylactic antibiotics in hospitalized patients. All the antibiotics prescriptions and files of the in-patients were screened manually. On Thursday, a list was obtained from the computerized medication order entry system to confirm the obtained data.
Antibiotics prescribed in the out-patient department, intensive care unit and in the operating room were not included.
Classification of Prophylaxis:
Antibiotics are classified into therapeutic and prophylactic antibiotics. Antibiotics which were given preceding a surgical intervention was taken into study.
Protocol presence and adherence:
Every prophylactic antibiotic prescribed were analyzed to check for adherence to protocol. Documentation was done whenever there was a reason for discontinuing the prophylaxis.
Data analysis:
Days on therapy are preferably used to determine the extent of antibiotics used. Extent of antibiotics used was recorded. Adherence to protocol was also recorded.
Conclusion
About one-third of antibiotics used outside the operating room were prophylactic antibiotics and it has reduced the surgical site infection significantly.
Acknowledgement: We would like to thank the staffs of General Surgery department for spending their valuable time and for their co-operation in completing the study.
Funding for the study: Nil Conflict of interest: Nil
I. Tables : TABLE 1:
ANTIBIOTIC PRESCRIPTIONS PER POINT PREVALANCE SURVEY
POINT PREVALENCE STUDY TOTAL NUMBER OF PRESCRIPTIONS
PROPHYLACTIC PRESCRIPTIONS
PPS 1 127 38
PPS 2 110 42
PPS 3 132 37
PPS 4 131 39
TOTAL 500 150
TABLE 2: ADHERENCE TO PROPHYLACTIC ANTIBIOTIC PRESCRIPTIONS PROPHYLACTIC PRESCRIPTIONS ADHERENCE TO PROTOCOL NON- ADHERENCE TO PROTOCOL 150 140 10
TABLE 3:
INDICATIONS FOR PROPHYLAXIS
INDICATIONS PROTOCOL ERCP yes
Spontaneous bacterial peritonitis yes
Stoma reversal no Chronic anastamotic leakage no After amputation for osteomyelitis yes Percutaneous kidney stone removal yes Laproscopy/Open nephrectomy yes
TABLE 4:
LIST OF PROPHYLACTIC ANTIMICROBIALS PRESCRIBED
ANTIBIOTICS NUMBER OF PRESCRIPTIONS
Trimethoprim/sulfamethoxazole 9
First generation cephalosporins 28
Fluroquinolones 7
Small spectrum penicillins 10 Amoxicillin/clauvulinic acid 15
Second generation cephalosporins 4
Broad spectrum penicillin 2
Macrolides 5
Aminoglycosides 15
Clindamycin 3
Metronidazole 20
Nitrofurantoin 9
Third generation cephalosporin 13
References
[1]. Dale W.BratzlerD.O., M.P.H.PeterM.HouckM.D.Surgical Infection Prevention Guideline Writers Workgroup.
[2]. Steinberg, James P. MD*; Braun, Barbara I. PhD†; Hellinger, Walter C. MD‡; Kusek, Linda RN, MPH†; Bozikis, Michele R. MPH†; Bush, Andrew J. PhD§; Dellinger, E Patchen MD¶; Burke, John P. MD∥; Simmons, Bryan MD; Kritchevsky, Stephen B. PhD
[3]. Single versus multiple dose antimicrobial prophylaxis for major surgery - a systematic review : Malcolm McDonald, Elizabeth Grabsch, Caroline Marshall, Andrew Forbes, First published: 21 January 2008.
[4]. Clinical trials of antimicrobials in surgery,James K. Watts M.B., B.S., F.R.A.C.S.,Peter J.
McDonald M.B., B.S., F.R.A.C.P., F.R.C.P.A. & Pamela J. Woods B.Sc., Dip. Comp. Sc., World Journal of Surgery volume.
