Compliance with international guidelines on antibiotic prophylaxis for elective surgeries at a tertiary-level hospital in the Philippines

Abstract

Background

Surgical site infections (SSIs) are a major cause of morbidity, associated with extended hospital stays, increasing costs and even death. Perioperative antibiotic prophylaxis has been proven to prevent SSIs. Guidelines have been published to promote best practice but studies continue to highlight poor compliance.

Objective

This study aimed to assess adherence to antibiotic prophylaxis guidelines in common surgical operations in the teaching hospital of the national university in the Philippines.

Methods

This was a medical records-based, cross-sectional study. Common surgical procedures included were breast surgery, enterostomy closure, open and laparoscopic colectomy, and open and laparoscopic cholecystectomy performed from December 2013 to March 2014. Data were extracted relating to patients’ demographic characteristics, types of surgery, prophylactic antibiotic choice, route, dose, timing, redosing and duration of prophylaxis. Observed antibiotic prophylaxis was compared with guidelines.

Results

Of the 244 cases that warranted prophylaxis, 93% were given antibiotics. Of these, 44% conformed with the guideline for type of antibiotic, 39% for dose, 100% for route, 45% for timing, 93% for redosing, and 67% for duration. Only 13% conformed to guidelines for all parameters of prophylaxis. Most cholecystectomies received Cefuroxime, no longer recommended by latest international guidelines. Of the laparoscopic surgeries, 38% received antibiotics earlier than the 1 hour before surgery recommended in latest guidelines.

Conclusions

Ensuring surgeons fully follow guidelines on antibiotic prophylaxis remains a challenge, as highlighted by this study and others conducted around the world. Awareness-raising initiatives might be beneficial at institutional level to improve compliance with best practice guidelines.