Prophylactic antibiotics practices at MNH Tanzania 2013

Abstract

Background Antibiotic prophylaxis is used to reduce the incidence of postoperative infection. For antibiotics to be used as prophylaxis duration should not exceed 24 hours in many of the procedures. Single preoperative dose of antibiotics is as effective as full day course therapy assuming uncomplicated procedure. It should target anticipated organism and is unnecessary if the patient is already receiving antibiotics that cover the likely pathogens. It should be given within one hour before incision commonly at the time of induction of anaesthesia and during prolonged procedures antibiotics should be readministred every 3hours with the exception of vancomycin, aminoglycosides and fluoroquinolones. However, many studies show that these guidelines are not followed. Many studies show use of prophylactic antibiotics when there is no clear indication for antibiotic prophylaxis, inappropriate drug use or duration of prophylaxis may be prolonged leading to increasing length of hospital stay, hospital cost, morbidity and mortality. This study was conducted to evaluate prophylactic antibiotics practices in elective surgical operation at MNH. Methods: Hospital based descriptive study of prophylactic antibiotics use among elective surgical patients. A total of 1146 elective operation done from July 2012 to January 2013 were included in the study. Prospective surgical audit of these elective surgeries were done using a structured questionnaire which was used to collect information on social demographic profile, operative information of timing of prophylactic antibiotics admininistration, postoperative antibiotic time, type of operation and choice of antibiotic given was done. Study population: All elective surgeries done during July 2012 to January 2013 Data analysis: was done using an SPSS computer program. Results: The majority of the respondents had primary education 68.8% with higher education being the least (3.7%). Among elective operation done there were 743(64.8%) male and 403(35.2%) female. Proportionally more patients were sixty years and above at 27.7%. Among elective surgery done at MNH 84.5% received prophylactic antibiotics. xii Eighty eight point four percent (88.4%) of clean contaminated wound which was eligible for prophylactic antibiotics received prophylactic antibiotics. However 72.1% of clean wound, 25% of contaminated and 83.3% of dirty wound received prophylactic antibiotics. Prophylactic antibiotic was administered to 89.4% of elective surgery patients in which there were external incision and 64% in which there were no external incision. The majority (57.3%) received prophylactic antibiotics one hour before surgery, and few (8.3%) received prophylactic antibiotics intraoperatively. The majority 836(86.4%) stopped prophylactic antibiotics more than five days post operatively while a few 0.9% stopped prophylactic antibiotics within twenty four hours post surgery. No additional prophyalactic antibiotics was given Intraoperatively. The majority of patients who underwent thyroidectomy(58.2%) received both metronidazole and ceftriaxone. Patients who underwent cystectomy almost half (47.8%) received ceftriaxone alone and half (47.8%) received both ceftriaxone and metronidazole. Overall combination of ceftriaxone and metronidazole were the most used prophylactic antibiotics (47.2%) followed by ceftriaxone alone (42.2%). Conclusion: Elective clean surgeries received unnecessary prophylactic antibiotics. Some clean contaminated surgeries did not receive prophylactic antibiotics. Contaminated and dirty elective surgeries received prophylactic antibiotics. Prophylactic antibiotic has been given post surgery in some of the surgeries. No additional prophyalactic antibiotics was given intraoperatively for the elective surgeries lasting more than 3hours. Prophylactic antibiotics has been prolonged post surgeries given in more than five days in the majority of elective surgeries. Combination of ceftriaxone and metronidazole was the most used prophylactic antibiotics followed by ceftriaxone alone. Recommendations: MNH should establish prophylactic antibiotics guideline which should be open and accessible by every member of the surgical team. Medical checklist should be practiced effectively. Frequent audit of prophylactic antibiotics use is needed to improve proper practices (prophylactic antibiotics uses). Surgeons should adhere to prophylactic antibiotics guidelines.