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Published on: October 20, 2012
Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications
Zikria Saleem1, Umar Ahsan2, Abdul Haseeb3
1Department of Pharmacy Practice, Faculty of Pharmacy, Bahuddin Zakaria University, Multan 60800, Pakistan.
Abstract:
Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3-4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.
Insights
Post-operative antibiotic use in Pakistan often exceeds guidelines, contributing to antimicrobial resistance (AMR). Interventions like antimicrobial stewardship programs are crucial for optimizing antibiotic use and reducing surgical site infections (SSIs).
Area of Science:
- Infectious Diseases
- Public Health
- Pharmacology
Background:
- Antimicrobial prophylaxis effectively reduces surgical site infections (SSIs).
- Concerns exist regarding the extent of post-operative prophylaxis, particularly in low- and middle-income countries (LMICs).
- Antimicrobial resistance (AMR) is a significant public health challenge in Pakistan.
Purpose of the Study:
- To investigate the patterns of antimicrobial use for SSI prevention in a Pakistani teaching hospital.
- To assess the appropriateness of antimicrobial choice, timing, and duration post-operatively.
- To identify areas for improvement in antimicrobial utilization to combat AMR.
Main Methods:
- Observational cross-sectional study involving 583 surgical patients.
- Data collection on prophylactic antimicrobial choice, timing, and duration.
- Analysis of antimicrobial prescribing practices in relation to established guidelines.
Main Results:
- Cephalosporins, particularly third-generation, were frequently used for all surgical procedures.
- Post-operative prophylaxis duration (3-4 days, often until discharge) exceeded guideline recommendations.
- Inappropriate antimicrobial choices and prolonged administration were observed.
Conclusions:
- Current antimicrobial prescribing practices for SSI prevention in Pakistan require optimization.
- Implementing antimicrobial stewardship programs is essential to improve antibiotic utilization.
- Addressing inappropriate antimicrobial use can help mitigate AMR and reduce SSI rates.
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