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

TL;DR

This study shows that training surgeons improves proper use of antibiotics before surgery, reducing unnecessary prescriptions but not preventing infections.

Contribution

The study demonstrates how surgeon training based on guidelines can improve antimicrobial prophylaxis adherence in general surgery.

Findings

Appropriate cefazolin dosage increased from 41% to 92.6% after training.

Antibiotic prescriptions at discharge decreased from 16.8% to 10.3% post-training.

Surgical site infection rates slightly increased from 9.9% to 13.3%, though not statistically significant.

Abstract

Surgical site infections (SSI) are characterized by infections occurring in the surgical incision site, organ or cavity in the postoperative period. Adherence to surgical antimicrobial prophylaxis (SAP) is paramount in mitigating the occurrence of SSIs. In this study, we aimed to evaluate the appropriateness of SAP use in patients undergoing surgical procedures in the field of general surgery according to the American Society of Health-System Pharmacists (ASHP) guideline and to determine the difference between the pre-training period (pre-TP) and the post-training period (post-TP) organized according to this guideline.

It is a single-center prospective study conducted in general surgery wards between January 2022 and May 2023, with 404 patients pre-TP and 406 patients post-TP.

Cefazolin emerged as the predominant agent for SAP, favored in 86.8% (703/810) of cases. Appropriate cefazolin dosage increased significantly from 41% (129 patients) in pre-TP to 92.6% (276 patients) in post-TP (p < 0.001), along with a rise in adherence to recommended timing of administration from 42.2% (133 patients) to 62.8% (187 patients) (p < 0.001). The proportion of patients receiving antibiotics during hospitalization in the ward postoperatively decreased post-TP (21–14.3%; p = 0.012), as did antibiotic prescription at discharge (16.8–10.3%; p = 0.008). The incidence of SSI showed a slight increase from 9.9% in pre-TP to 13.3% in post-TP (p = 0.131).

Routine training sessions for surgeons emerged as crucial strategies to optimize patient care and enhance SAP compliance rates, particularly given the burden of clinical responsibilities faced by surgical teams.

The online version contains supplementary material available at 10.1186/s40001-024-01938-w.

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