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Use of surgical antibiotic prophylaxis and the prevalence and risk factors associated with surgical site infection in a tertiary hospital in Malaysia

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Abstract

Introduction

Surgical antibiotic prophylaxis (SAP) is effective in reducing surgical site infections (SSIs). However, inappropriate use of SAP increases the risk of SSIs and antibiotic resistance.

Objectives

To evaluate the rate of compliance with timing and duration of SAP and to evaluate the prevalence and risk factors associated with SSIs.

Method

This retrospective study was conducted among surgical patients in a tertiary hospital in Malaysia from June to August 2019. Patients’ electronic medical records were reviewed for data collection and the data were analysed using both descriptive and inferential analyses.

Results

This analysis included 127 surgical procedures in patients with a mean age of 43.4 ± 22.3 years and a male preponderance (64%). Only 37.8% received pre-operative SAP, with metronidazole (27.4%), amoxicillin-clavulanic acid (25.8%) and cefoperazone (22.6%) being the most common antibiotics. Overall, the timing of SAP was inappropriate in 92.1% of the procedures. Approximately 59% received SAP for more than 24 h. Those who received pre-operative antibiotics were less likely to receive SAP beyond 24 h (odds ratio (OR): 0.219; 95% confidence interval (CI) 0.082–0.588; p = 0.003). The prevalence of SSI was 16.5% and was associated with the length of hospital stay after surgery (OR: 1.144; 95 CI 1.035–1.265; p = 0.008) and duration of surgery (OR: 1.006; 95% CI 1.000–1.012; p = 0.038), but these significances disappeared in a multivariate analysis.

Conclusion

Inappropriate use of SAP was observed including late administration and long duration of antibiotic use. The prevalence of SSIs is high and is associated with duration of surgery and length of hospital stay after surgery. Pre-operative SAP may reduce treatment duration. Antimicrobial stewardship intervention is recommended and infection control strategies should be strengthened.

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Acknowledgements

The authors wish to thank all the Heads of Surgery, Pharmacy and Records Departments for the assistance they provided during data collection.

Author information

Authors and Affiliations

  1. Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang, Malaysia

    Nur Farahiah Zammari

  2. Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia

    Usman Abubakar

  3. Department of Surgery, Kulliyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia

    Shahidah Che Alhadi

  4. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xian Jiaotong University, Xi’an, China

    Faiz Ullah Khan

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  1. Nur Farahiah Zammari
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  2. Usman Abubakar
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  4. Faiz Ullah Khan
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Corresponding author

Correspondence to Usman Abubakar.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Conflict of interest

The authors declare that there are no conflicts of interest.

Ethics approval

Ethics approval was obtained from the IIUM Research Ethics Committee, reference number: IIUM/504/14/11/2/IREC 2020-104.

Consent to participate

The Human Research Ethics Committee granted a waiver for patient informed consent due to the retrospective nature of the study.

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Not applicable.

Availability of data and material

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable

Author contributions

AU and NFZ designed the study and collected the data, analysed the data and wrote the first draft of the manuscript. SCA contributed in data collection and SCA and FUK reviewed the manuscript draft. All the authors approved the manuscript for submission.

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Zammari, N.F., Abubakar, U., Che Alhadi, S. et al. Use of surgical antibiotic prophylaxis and the prevalence and risk factors associated with surgical site infection in a tertiary hospital in Malaysia. Drugs Ther Perspect 38, 235–242 (2022). https://doi.org/10.1007/s40267-022-00914-w

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