Surgical Antimicrobial Prophylaxis Appropriateness and Its Impact on Surgical Site Infection Rate

Surgical antimicrobial prophylaxis (SAP) is a critical component of postoperative infection prevention, but its misuse is a widespread global issue. This study aims to assess SAP utilization patterns and appropriateness of SAP in terms of choice, timing of administration, and duration of SAP, and to evaluate possible correlation of SAP compliance with reduction in surgical site infection (SSI) rates.

A facility-based prospective cross-sectional study was conducted over a period of 6 months to evaluate the prescribing patterns of SAP and the incidence of SSIs. Prophylactic antimicrobial use was considered appropriate when the correct antimicrobial was administered for the appropriate indication, at the correct time, and for the recommended duration, in alignment with institutional protocols.

The findings suggest a general improvement in SAP adherence over the 6-month period, with a peak of 83% in May-24 coinciding with the lowest recorded SSI rate (0.64%). Conversely, the highest SSI rate (5.14%) in Jan-24 corresponded with the lowest adherence (60%), reinforcing the association between proper SAP compliance and reduced infection rates. SAP adherence improvement correlates with reduced SSI rates, but there is still a need to reduce prolonged SAP use.

The relationship between SAP adherence and SSI rates underscores the importance of evidence-based antimicrobial stewardship. Strengthening compliance with established protocols and aligning SAP practices with international guidelines will be critical in sustaining low SSI rates while minimizing antibiotic resistance risks. Further, assessing SAP using days of therapy/100 patient-days (DOT/100 PD) data could provide valuable insights into adherence trends and potential areas for improvement.