Practice of Antibiotic Prophylaxis in Abdominal Hysterectomy at King Chulalongkorn Memorial Hospital
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Abstract
Objectives: To evaluate the rate of adherence to the guidelines for antibiotic prophylaxis using in elective abdominal hysterectomy.
Materials and Methods: Retrospective descriptive study was conducted by reviewing medical records of women underwent elective abdominal hysterectomy at King Chulalongkorn Memorial Hospital (KCMH) from January to December 2019. Cases who having bacterial infection, surgical procedures on gastrointestinal or urinary tract, operative time longer than 3 hours, blood loss more than 1,500 milliliters, immunosuppression, or receiving immunosuppressive agents were excluded. Logistic regression analysis was used to determine factors associated with appropriate use of antibiotics prophylaxis.
Results: A total of 588 women underwent elective abdominal hysterectomy in the study period. Among 391 eligible patients with a mean age of 48.7 years, 326 cases (83.4%) had benign diseases on final diagnosis. Most of the operations used transverse skin incision and a median operative time and blood loss were 90 minutes and 200 milliliters, respectively. Use of antibiotics prophylaxis that adherent to the guidelines was demonstrated in 63 cases (16.1% of all cases, 19.3% of cases without staging procedures). Among cases without staging procedures, operation by residents was the only factor that significantly increased appropriate use of antibiotics prophylaxis with adjusted odds ratio of 6.84 (95% confidence interval 3.40-13.74).
Conclusion: Uses of antibiotic prophylaxis for abdominal hysterectomy at KCMH were mostly not adherent to the guidelines. An antibiotic stewardship program needs to be implemented to improve the practice.
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References
ACOG Practice Bulletin No. 195: Prevention of infection after gynecologic procedures. Obstet Gynecol 2018;131:e 172-89.
Ayeleke RO, Mourad S, Marjoribanks J, Calis KA, Jordan V. Antibiotic prophylaxis for elective hysterectomy. Cochrane Database Syst Rev 2017;6:CD004637.
Van Eyk N, van Schalkwyk J. No. 275-Antibiotic prophylaxis in gynaecologic procedures. J Obstet Gynaecol Can 2018;40:e723-33.
National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. NICE guideline [Internet]. 2019 [cited 2021 October 6]. Available from: https://www.nice.org.uk/guidance/ng125/resources/surgical-site-infections-prevention-and-treatment-pdf-66141660564421.
Su HY, Ding DC, Chen DC, Lu MF, Liu JY, Chang FY. Prospective randomized comparison of single-dose versus 1-day cefazolin for prophylaxis in gynecologic surgery. Acta Obstet Gynecol Scand 2005;84:384-9.
Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf 2014;5:229-41.
Gouvêa M, Novaes Cde O, Pereira DM, Iglesias AC. Adherence to guidelines for surgical antibiotic prophylaxis: a review. Braz J Infect Dis 2015;19:517-24.
Daniel WW, Cross CL. Biostatistics: a foundation for analysis in the health sciences. 10th ed. New Jersey: John Wiley & Sons 2013:192.
Sae-Tia L, Chongsomchai C. Appropriateness of antibiotic prophylaxis in gynecologic surgery at Srinagarind Hospital. J Med Assoc Thai 2006;89: 2010-4.
Phoolcharoen N, Nilgate S, Rattanapuntamanee O, Limpongsanurak S, Chaithongwongwatthana S. A randomized controlled trial comparing ceftriaxone with cefazolin for antibiotic prophylaxis in abdominal hysterectomy. Int J Gynaecol Obstet 2012;119:11-3.
Uppal S, Harris J, Al-Niaimi A, Swenson CW, Pearlman MD, Reynolds RK, et al. Prophylactic antibiotic choice and risk of surgical site infection after hysterectomy. Obstet Gynecol 2016;127:321-9.
Akkour KM, Arafah MA, Alhulwah MM, Badaghish RS, Alhalal HA, Alayed NM, et al. A comparative study between a single-dose and 24-hour multiple-dose antibiotic prophylaxis for elective hysterectomy. J Infect Dev Ctries 2020;14:1306-13.
Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health 2018;6:e619-29.
Tan JA, Naik VN, Lingard L. Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections. Qual Saf Health Care 2006;15:32-8.
Mwita JC, Ogunleye OO, Olalekan A, Kalungia AC, Kurdi A, Saleem Z, et al. Key issues surrounding appropriate antibiotic use for prevention of surgical site infections in low- and middle-income countries: a narrative review and the implications. Int J Gen Med 2021;14:515-30.
Abubakar U, Syed Sulaiman SA, Adesiyun AG. Utilization of surgical antibiotic prophylaxis for obstetrics and gynaecology surgeries in Northern Nigeria. Int J Clin Pharm 2018;40:1037-43.