Evaluation of adherence to guidelines for the management of antibiotic surgical prophylaxis in a Guatemala City hospital

Abstract

Purpose: In surgical patients, 2% to 5% contract surgical site infections resulting in use of broad spectrum antibiotics. In order to prevent emergence of serious infections as a result of surgery, antimicrobial stewardship teams implement antibiotic surgical prophylaxis guidelines, monitoring adherence to ensure the appropriate use of antibiotics in these patients. The objective was to determine adherence to local surgical prophylaxis guidelines as an intervention in the implementation of the Antimicrobial Stewardship Program. Methods & Materials: A prospective descriptive cross-sectional study was carried out in 5 surgical wards for a period of two months to prospectively review patient charts. The study aimed to determine adherence to the local surgical prophylaxis guidelines as part of the first year of the antimicrobial stewardship program in the Roosevelt hospital in Guatemala City. Descriptive statistics are presented to describe the proportion of patients who received antibiotic prophylaxis, the adherence antibiotic surgical prophylaxis dosing protocol was determined, including compliance of dosing interval and duration. Results: Eighty-three consecutive clinical records were reviewed. Eighty-five percent of surgical patients were prescribed antibiotic prophylaxis, most patients received cefazolin (20%), followed by ceftriaxone plus clindamycin (18%), and ampicillin/sulbactam plus amikacin (16%). We encountered non-adherence to antibiotic surgical prophylaxis dosing in 73% of cases. Forty-six percent of antibiotics were prescribed in compliance with administration interval, but 53% were not in compliance with antibiotic duration. Conclusion: Findings on the adherence to antibiotic surgical prophylaxis protocol document severity in the over use of antibiotics in five surgical wards in Guatemala. Poor adherence to the antibiotic emphasizes the need for development of multidisciplinary interventions to optimize antimicrobial use.