Concordance Between Surgical Antibiotic Prophylaxis Practice at a University Tertiary Care Hospital and the Guideline-Based Recommendations of the Surgical Infection Society of Thailand
Walaiporn Wangchinda MD¹, Nawakrit Kijsuwanpaisarn², Pinyo Rattanaumpawan MD¹, Visanu Thamlikitkul MD¹
Affiliation : ¹ Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ² Medical Student, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To determine the concordance between surgical antibiotic prophylaxis (SAP) practices at Siriraj Hospital and the guideline-based
recommendations for prevention of surgical site infection developed by the Surgical Infection Society of Thailand.
Materials and Methods : Case record forms and medical records of 303 hospitalized patients at Siriraj Hospital who received antibiotics for prevention of surgical site infection over 24 hours on August 7, 2018 were reviewed for indication of antibiotic prophylaxis, choice of antibiotic, time of initial antibiotic administration, redosing of antibiotic, and duration of antibiotic to determine concordance with the guideline-based recommendations of the Surgical Infection Society of Thailand.
Results : Two hundred twenty-one patients (mean age: 48.4 years, 62.1% female) had data suitable for inclusion in the final analysis. Cefazolin was the most commonly prescribed initial antibiotic for surgical prophylaxis. Fosfomycin, which is not listed in the guideline, was commonly used for neurosurgical prophylaxis. Regarding the concordance between SAP practice and the guideline-based recommendations, 93.8% had indications for SAP, 67.2% received the correct choice of antibiotic, 89.9% received the appropriate initial dose of antibiotic, 82.8% received antibiotic within 60 minutes before surgical incision, 26.1% received appropriate redosing in patients who required additional dose of antibiotic, 32.3% received antibiotic prophylaxis within or for 24 hours, and the proportion of patients in concordance with all guideline-based parameters was 20.9%. Two patients received antibiotic regimens that were discordant with the guidelines developed surgical site infection.
Conclusion : Concordance between SAP practices at Siriraj Hospital and the guideline-based recommendations for the prevention of surgical site infection developed by the Surgical Infection Society of Thailand was found to be low with only 20.9% of study patients having met all guideline parameters. Interventions to promote, monitor, and sustain the appropriate use of SAP at Siriraj Hospital are urgently needed.
Received 12 October 2020 | Revised 11 January 2021 | Accepted 18 January 2021
doi.org/10.35755/jmedassocthai.2021.05.12363
Keywords : Concordance, Surgical antibiotic prophylaxis practice, SAP, Guideline-based recommendations, Surgical Infection Society of Thailand
