Antibiotics consumption in neurosurgery versus appendectomy: a call for antibiotic stewardship initiatives.

Background and aims: Surgical site infection (SSI) remains a significant global health concern, including in Indonesia. The administration of prophylactic antibiotics plays a pivotal role in the prevention and the reduction in mortality rates associated with SSIs. Prophylactic antibiotic use is recommended in surgical procedures that are at risk of infection, including in clean surgical operations that last more than three hours and clean-contaminated surgeries. The objective of this study was to analyze the quantity of prophylactic antibiotic consumption and to compare the consumption of antibiotics between neurosurgery (clean surgery) and appendectomy (clean-contaminated surgery).

Methods: Data in this observational study were obtained from the medical records of patients who underwent neurosurgery and appendectomy at two hospitals in Surabaya: one private and one public hospital. The quantity of antibiotic consumption will be analyzed descriptively and presented as a defined daily dose (DDD) per 100 bed days.

Results: Research findings revealed a higher quantity of antibiotic consumption in elective neurosurgery, representing 47.43 DDD/100 bed-days, in comparison to 21.26 DDD/100 bed-days and 76.34 DDD/100 bed-days in elective and emergency appendectomy, respectively. The most frequently used antibiotics were broad-spectrum antibiotics, which included cefixime (36.91 DDD/100 bed-days) and ceftriaxone (5.45 DDD/100 bed-days) in elective neurosurgery; and ceftriaxone (14.94 vs 50.86 DDD/100 bed-days) and metronidazole (5.75 vs 19.16 DDD/100 bed-days) in elective and emergency appendectomy, respectively.

Conclusion: The consumption of prophylaxis antibiotics remains a significant concern. In order to develop strategies to prevent bacterial resistance through an antibiotic stewardship program, it is essential to evaluate antibiotic consumption and monitor trends over time.