• Nu S-Au Găsit Rezultate

View of A Study on Role of Antimicrobials in General Surgery


Academic year: 2022

Share "View of A Study on Role of Antimicrobials in General Surgery"

Arată mai multe ( pagini)

Text complet


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,


[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


A four point prevalence study was conducted in which the patients were screened for the use of prophylactic antibiotics.


Of 500 antibiotics prescriptions 150 antibiotics were given as prophylaxis and adherence to protocolwasseenin 140 cases


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.


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.


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.



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:




PPS 1 127 38

PPS 2 110 42

PPS 3 132 37

PPS 4 131 39

TOTAL 500 150





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




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


[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.



The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh repair of primary inguinal hernia: a multicenter double-blind

The study done on a number of 5 137 237 patients admitted to hospitals in Romania in 2008, in order to find out which was the pattern of using hospital services by the

The aim of this study was to determine the effect of mobile-based education of patient's privacy principles on the knowledge, attitude and performance of operating room staff in

A cross sectional study design was carried out of the study to achieve this study throughdetermine of parents burden of care among children with mental

The Antibiotic Resistance of Staphylococcus Aureus Isolated from Diabetic Foot Ulcers in a Tertiary Care

The distinction between first order truth claims and second order grammatical reflection stems from the application of the linguistic metaphor to religion and from allowing

The Constitution of the Republic of Albania regulates three situations that require extraordinary measures: war situation, state of emergency and state of natural

The effects of temperature on thermal conductivity enhancement of different nanofluids and the base fluids were measured within the range of 20 0 C – 60 0 C the

Identity is thus constructed in interaction, which means that out of a whole host of potential identity features, those features become salient which permit a differentiation of

The modification of the promotion criteria in the area of medical university education triggered an increase in the number of articles published by the

Thus, if Don Quixote is the idealist, Casanova the adventurous seducer, Werther the suicidal hero, Wilhelm Meister the apprentice, Jesus Christ will be, in the audacious and

Properly managed emotions are not harmful; they are part of our life, help in the process of healing or eliminating stress.. Keywords: negative; positive emotions; behavior;

The number of vacancies for the doctoral field of Medicine, Dental Medicine and Pharmacy for the academic year 2022/2023, financed from the state budget, are distributed to

The results of the parsimonious ECM revealed amongst others that the recent global financial crisis does not have a severe negative impact on the performance of

Moreover, research done in Ethiopia on this regard is limited.Hence,this study was done to identify the quality of essential newborn care and associated factors in

On analyzing the use of Cephalosporins in post-operative surgery, it was found that, in Appendectomy, out of 15 surgical cases, 8 received a combination of Cefoperazoneand

The present study was supported by Revathy .N (2018 ) was to find out the Effectiveness of group reminiscence therapy on levels of life satisfaction and

This study was carried out in one of the orchards in Al Saqlawiyah region of Anbar governorate to find out the effect of comercial formulation Bacillus

This study was conducted as a Cross sectional study, to evaluate the role of ultrasonography in evaluation and differential diagnosis of various liver pathologies..

The objective of this cross-sectional study was to find out the potential benefits of the MMA, so to achieve this there was a comparison of push up test, crunches test, plank

The present study was undertaken to find out the clinical profile and outcomes of neonates admitted with Low birth weight in a tertiary care hospital in Suburban

Hypertension is recognized as a risk factor that will continue in the future, and a study was undertaken to find out how to quickly and safely recover elevated blood

The high incidence of lateral wall fractures in the present study is due to the fact that our hospital is situated near a motor highway and 78 % of patients were involved in