Assessment of Surgical Antimicrobial Prophylaxis Practices in a Tertiary Hospital in Iraq

Aim: Surgical Antimicrobial Prophylaxis (SAP) is critical in reducing surgical site infections (SSIs). However, inappropriate antibiotic use remains common concern in many healthcare settings. Therefore, the aims was to assess the use of surgical antibiotic prophylaxis.

Materials and Methods: A retrospective cross-sectional study was conducted among 419 discharged surgical and gynecological patients at Al-Salam Teaching Hospital, Mosul, Iraq, during August 2023. Patient records were analyzed for SAP indication, antibiotic selection, timing, and duration according to international guidelines. This study aimed to assess both the prescribing patterns and the appropriateness of surgical antimicrobial prophylaxis practices.

Results: SAP was indicated for most patients; however, appropriate antibiotic selection was documented in only 35.1%. Ceftriaxone was predominantly prescribed (73.0%), followed by amoxicillin (8.6%), and cefotaxime (6.2%). Furthermore, most patients received antibiotics after surgical incision, and the duration exceeded 7 days in a significant proportion of cases, contrary to standard recommendations. Of 419 patients, 117 (27.9%) received appropriate prophylaxis and 302 (72.1%) inappropriate prophylaxis. The mean antibiotic cost per patient was 2.16 USD in the appropriate group compared with 4.85 USD in the inappropriate group. Inappropriate prophylaxis accounted for 85.3% of the total antibiotic expenditure.

Conclusions: The study highlights substantial gaps in adherence to SAP guidelines, emphasizing inappropriate antibiotic selection, timing, and excessive duration. These findings underscore the urgent need for implementing antimicrobial stewardship interventions to optimize SAP practices and reduce potential antibiotic resistance and SSIs.