Abstract
Background – Postoperative wound infection is an important cause of morbidity in surgical patients and antibiotic prophylaxis forms one of the important preventive measures.
Aims and Objectives – This study was performed in a major general hospital to establish the efficacy of antibiotic prophylaxis in clean general surgeries.
Materials and Methods – The study was done in 100 cases divided in 2 groups, one of which was given a single dose of ceftriaxone within 2 hours of operative incision without any postoperative antibiotics and the other was given routine postoperative antibiotics. Postoperative evaluation was done for development of fever or wound infection.
Observation and Results – Mean age was 35 and 33 in both groups while mean operative time was 45 – 53 minutes. Majority of cases performed were of hernioplasty. Various other factors such as length of incision, use of electrocautery and postoperative hospital stay were considered. Incidence of infection in both groups was similar but cost reduction of 88.11% was achieved in the first group.
Conclusion – The restriction of antibiotic usage in preoperative period and omission of it in postoperative period didn’t result in increase in incidence of surgical site infection. However significant cost reduction is achieved in the cases where preoperative prophylactic antibiotics were used and hence can be advocated in clean general surgeries.
Key Words: Preoperative, Antibiotic, Prophylaxis, Clean, Postoperative, Infection
References
1. Dellinger EP, Gross PA et al – ‘Quality standard for antimicrobial prophylaxis in surgical procedures’ – Cli Infec Diseases 1994; 18: 422-7
2. Platt R, Zuker JR ET AL – ‘Prophylaxis against wound infection following herniorraphy or breast surgery’ – Jour. Infec. Diseases 1992; 166: 556-60
3. Advoc commite on trauma, National research council division of medical sciences – ‘Postoperative wound infections : Influence of ultraviolate irradiation of operating room and varios other factors’ – Ann. Surg 1964; 160 :2
4. Dar LR, Fayaz F – ‘Prophylactic antibiotics in elective major gynaecological surgery : single periopera-tive dose vs multiple postoperative doses’ Mother child 1999; 37: 51-3
5. Haley RW, Schaberg DR et al – ‘Extra charges and prolongation of stay attributable to nosocomial infections: a prospective intrahospital comparision’ – Am. J. Med. 1981; 70: 51-8
6. Heydemann JS, Nelson CL et al – ‘Short term preventive antibiotics’- Cli. Orthop.1986; 205:184-7
7. Classen DC, Evans RS et al – ‘The timing of prophylactic administration of antibiotics and risk of surgical wound infection’ – N Engl Jour Med 1992 Jan 30; 326(5):337-9
8. Creamer E., Cunny RJ et al – ‘Sixteen years surveillance of surgical sites in an irish acute care hospital’ – Infec control hosp Epedemiol 2002; 23:36 - 40
9. McDonald LC, Yu HT et al – ‘Use and abuse of surgical antibiotic prophylaxis in hospitals in Taiwan’ – J Formos Med Assos 2001; 100: 5-13
10. Wenzel RP – ‘Preoperative antibiotic prophylaxis’ – N Engl J Med 1992; 326:337-9
11. Bergamini TM., and MC Polk – ‘The importance of tissue antibiotic activity in the prevention of operative wound infection’- J Antimicrob 1989;23:301-313
12. Fritsche TR, Sader HS et al –‘Comparitive activity and spectrum of broad-spectrum f3-lactams tested against 12.295 staphylococci and stretrococci: report from the sentry antimicrobial surveillance program’ – Diagn Microbiol Infect Dis 2003; 47(2):435-40
13. Woodfield JC, et al – ‘ A comparison of the prophylactic efficacy of ceftiaxone and cefotaxime in abdominal surgery’ – Am J Surg 2002;185:45-9
14. Sabiston Textbook of Surgery, Biologic basis of surgical practice. 17th edition WB Saunders Philadelphia Pg.
15. Perry TR, Schentag JJ –‘Clinical use of ceftriaxone a pharmacokinetic-pharmacodynamic perspective on the impact of minimum inhibitory concentration and serum protein binding’ Clinical Pharmacokinetics – Volume 40, 2001, pp.685694(10)
16. Knight R, Charbonneau P, Ratzer E et al–‘Prophylatice antibiotics are not indicated in clean general surgery cases’ – Am J Surg 2001;182:682-6
17. Classen DC, Evans RS et al–‘ The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection’ – N Engl J Med 1992; 30:326(5):337-9
18. Wattal C, Oberoi JK – ‘Recent Advances in control and prophylaxis of surgical infections, recent advances in surgery-10, Roshan Lal Gupta’ – Jaypee brothers, New Delhi 2006. Pg. 76-104
19. Mary T.Hawn, Josna S., et al –‘Timing of surgical antibiotic prophylaxis and the risk of surgical site infection’ – JAMA Surg 2013;148(7):649-657
20. Brij B. Agrawal –‘ Prophylactic antibiotic in surgery’ – JISMA 2013;26:207
21. J.Wesley Alexander et al –‘Updated recommendation for control of surgical site infections’ – Annals of Surgery 2011;253(6):1082-1093
22. H. LLenva, J.R.Khambholja –‘Recent Advances of antibiotics in clean surgical prophylaxis vs conventional recommended 3 doses of antibiotics’ – Gujarat Medical Journal, Aug 2014;69:412:96-98