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Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani.


Abstract

Background: Prophylactic antimicrobials have an important adjuvant role in the prevention of Surgical Site Infection
(SSI), which is one of the most preventable causes of post-operative complication. In India, due to lack of adequate
information and guidelines for antimicrobial prophylaxis in surgery there is a need to generate baseline data on the
pattern of use of prophylactic antimicrobials.

Aims & Objective: This study is aimed to analyze the pattern of surgical chemoprophylaxis and surgical site infection
(SSI) rate in patients who underwent elective orthopedic surgical procedure.

Material and Methods: A prospective, observational study was performed on patients undergoing surgery, in a
tertiary care teaching hospital. Data were collected in a pro-forma which included the patients’ details, prescriptions
from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by
Centre for Disease Control criteria was recorded.

Results: Total 305 patients were enrolled over a period of one year. In 237 (77.70%) patients antimicrobials
prescribed by generic name. In preoperatively and intraoperatively, all the patients received parenteral antimicrobial.
Postoperatively, 294 (96.40%) patients received only parenteral antimicrobials while in 11 (3.60%) patients received
parenteral antimicrobials followed by oral antimicrobials. Preoperatively antimicrobials started 12 hours prior to
surgery. Average duration of antimicrobials given postoperatively was 5.05 ± 1.14 days. Third generation
Cephalosporins and Aminoglycosides were prescribed most frequently. Average number of antimicrobials used per
patient was 4.40 ± 1.05. In follow up 37 (13.03%) patients developed SSI and most common isolated organism was
Staphylococcus aureus.

Conclusion: Surgical chemoprophylaxis was inappropriate in terms of choice of antimicrobial agent, timing of
administration as well as the total duration of prescription, in majority of the cases, leading to higher SSI. Interventions
are warranted to promote the development, dissemination and adoption of evidence based guidelines for antimicrobial
prophylaxis.

Key words: Antimicrobial Prophylaxis; Surgical Site Infection; Orthopedic






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