Assessment of Antibiotic Prophylaxis in Surgical Patients at a Referral Teaching Hospital in Western Iran

Antibiotic prophylaxis is often used by surgeons to prevent surgical site infection (SSI) following operations. Despite the availability of several national guidelines for proper antibiotic prophylaxis, adherence to guideline recommendations, especially in developing countries, is still sub-optimal. This study aimed to assess adherence to the American Society of Health-System Pharmacists (ASHP) guidelines for prophylactic antibiotic use among surgeons in a referral hospital in western Iran.

This prospective cross-sectional study was conducted in surgery wards of a tertiary hospital affiliated with Hamadan University of Medical Sciences, Hamadan, Iran, for six consecutive months from February 1 to July 31, 2019. The records of 264 patients who were randomly chosen from patients admitted to surgery wards were reviewed. The appropriateness of parameters of surgical antibiotic prophylaxis, including indication, antibiotic choice, dose, timing of the first dose, and duration of prophylaxis, was assessed against ASHP guidelines.

A total of 248 patients (93.94%) received antibiotic prophylaxis. Only in 32.2% of the procedures, full adherence to all parameters of the AHSP guidelines was achieved. In a significant percentage of procedures, prophylactic antibiotics were administered inappropriately for more than 24 hours (59.21%). Regarding the antibiotic selection (92.1%), dose (88.6%), and timing of administration (89.9%), the rate of adherence to guidelines recommendations was relatively satisfactory in our hospital.

Our survey demonstrated that the adherence of surgeons to antibiotic prophylaxis guidelines was inadequate in our hospital, and there is still considerable room for improvement, especially in the process of discontinuation of antimicrobial prophylaxis.