# Adherence to perioperative antimicrobial prophylaxis in cancer surgeries: A single-center retrospective study from Oman

## TL;DR

This study from Oman found that adherence to surgical antibiotic guidelines in cancer surgeries was only 66%, with poor re-dosing practices linked to higher infection risks.

## Contribution

The study provides new insights into antimicrobial prophylaxis adherence in cancer surgeries at a single oncology center in Oman.

## Key findings

- Overall adherence to SAP protocols was 65.9%, with re-dosing showing the lowest compliance.
- Non-adherent cases had a significantly higher surgical site infection rate (15.7% vs 4.7%).
- Longer surgery duration and gynecologic oncology procedures were independently linked to non-adherence.

## Abstract

•Surgical antimicrobial prophylaxis adherence was suboptimal (65.9%) in cancer surgery.•Weight-based dosing showed near-universal compliance.•Antibiotic choice, duration, and re-dosing remained suboptimal.•Prolonged procedures warrant targeted stewardship efforts.

Surgical antimicrobial prophylaxis adherence was suboptimal (65.9%) in cancer surgery.

Weight-based dosing showed near-universal compliance.

Antibiotic choice, duration, and re-dosing remained suboptimal.

Prolonged procedures warrant targeted stewardship efforts.

Surgical antimicrobial prophylaxis (SAP) is essential for preventing surgical site infections (SSIs), particularly in oncology patients. However, adherence to SAP guidelines globally remains inconsistent. This study evaluated adherence to SAP protocols at a tertiary oncology center and assessed associated factors with non-adherence and SSI outcomes.

A retrospective review was conducted at Sultan Qaboos Comprehensive Cancer and Research Center (SQCCCRC) from August 2022 to July 2023. SAP prescriptions were evaluated for four criteria: antibiotic choice, weight-based dosing, re-dosing, and duration. Non-adherence to any of the four components considered non-adherent. Demographics, cancer type, surgical procedure, wound classification, procedure duration, SSIs, and microbiology results were extracted from patient records. We used bivariate analysis and multivariable logistic regression model to identify factors associated with non-adherence. The cumulative incidence of SSIs was also calculated.

Of the 261 surgeries reviewed, overall adherence to SAP protocols was 65%. Weight-based dosing adherence was highest (99.6%), while re-dosing adherence was lowest (80%). Univariate analyses showed non-adherence linked to higher patient weight (P = 0.041), male gender (P = 0.01), wound classification (P < 0.001) and longer surgery duration (P < 0.001), while breast surgery had better adherence (P = 0.0025). In the multivariable model, non-adherence was independently associated with gyne-oncology procedures (odds ratio [OR] = 7.76, 95% confidence interval [CI] = 2.13-30.86; P = 0.002) and longer surgery duration (OR = 1.35 per hour, 95% CI = 1.16-1.58; P = 0.0001). The cumulative incidence of SSIs was 8.4%, comprising 52% organ-spaced, 33.3% deep SSI, and 14% superficial SSIs. Non-adherent cases were more likely to have SSI compared to adherent (15.7% vs 4.7%, P = 0.004).

The study found suboptimal overall adherence to SAP protocols, particularly in re-dosing practices. Targeted antimicrobial stewardship interventions are warranted to address these gaps and minimize infection risk, especially in high-risk oncology populations.