Optimization of appropriate antimicrobial prophylaxis in general surgery: a prospective cohort study

Area of Science:

• Infectious Diseases
• Surgical Care
• Pharmacology

Background:

• Surgical site infections (SSIs) are a significant postoperative complication.
• Adherence to surgical antimicrobial prophylaxis (SAP) guidelines is crucial for SSI prevention.
• Evaluating SAP appropriateness is key to optimizing patient outcomes.

Purpose of the Study:

• To assess the appropriateness of SAP use in general surgery patients based on ASHP guidelines.
• To compare SAP practices and outcomes between pre-training and post-training periods.
• To identify the impact of training interventions on SAP compliance.

Main Methods:

• A single-center prospective study involving 810 general surgery patients (404 pre-training, 406 post-training).
• Data collected between January 2022 and May 2023.
• Comparison of SAP appropriateness, including cefazolin dosage and timing, and SSI incidence pre- and post-training.

Main Results:

• Cefazolin was the primary SAP agent (86.8%).
• Appropriate cefazolin dosage increased from 41% to 92.6% (p<0.001).
• Adherence to SAP timing improved (42.2% to 62.8%, p<0.001), with decreased postoperative antibiotic use and discharge prescriptions.
• SSI incidence slightly increased from 9.9% to 13.3% (p=0.131).

Conclusions:

• Routine surgeon training significantly enhances SAP compliance and appropriateness.
• Training interventions are vital for optimizing surgical antimicrobial prophylaxis strategies.
• Further research may be needed to address the slight increase in SSI incidence post-training.