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An observational cohort study on the effects of extended postoperative antibiotic prophylaxis on surgical-site infections in low- and middle-income countries. The British journal of surgery Clean Cut Investigators Group, Nofal, M. R., Zhuang, A. Y., Gebeyehu, N., Starr, N., Haile, S. T., Woldeamanuel, H., Tesfaye, A., Alemu, S. B., Bekele, A., Mammo, T. N., Weiser, T. G., Abdukadir, A. A., Abebe, B. M., Admasu, A. K., Alito, T. A., Ambulkar, R., Arimino, S., Arusi, M., Aynalem, N., Bajaj, V., Delelo, T. S., Gutu, M., Habte, F., Hurrisa, G. A., Kunte, A., Rocabado, K., Shiferaw, M. A., Harrell-Shreckengost, C., Tiruneh, A., Zamorano, R., Abreha, M., Aguilera, C., Lima, B., Kebede, H. 2024; 111 (1)

Abstract

BACKGROUND: Worldwide, approximately one in six inpatient antibiotic prescriptions are for surgical-infection prophylaxis, including postoperative prophylaxis. The WHO recommends against prolonged postoperative antibiotics to prevent surgical-site infection. However, in many low- and middle-income countries, postoperative antibiotic prophylaxis is common due to perceptions that it protects against surgical-site infection and data informing recommendations against antibiotic administration are largely derived from high-income countries. The aim of this study was to describe postoperative antibiotic-prescribing patterns and related surgical-site infection rates in hospitals in low- and middle-income countries.METHODS: Patients from 19 hospitals in Ethiopia, Madagascar, India, and Bolivia with wound class I and II operations were included. Data on antibiotic administration, indication, surgical-site infection, length of hospital stay, and adherence to perioperative infection-prevention standards were collected by trained personnel. The association between postoperative antibiotic prophylaxis for greater than or equal to 24 h and surgical-site infection was analysed via modified robust Poisson regression, controlling for patient and procedural factors and degree of adherence to perioperative infection-prevention practices.RESULTS: Of 8714 patients, 92.9% received antibiotics for prophylaxis after surgery and 27.7% received antibiotics for greater than or equal to 24 h. Patients receiving postoperative prophylaxis for greater than or equal to 24 h did not have lower surgical-site infection rates (Relative risk 1.09 (95% c.i. 0.89 to 1.33); P = 0.399), but the length of hospital stay was 1.4 days longer (P < 0.001).CONCLUSION: Prolonged postoperative antibiotics did not reduce surgical-site infection, but pervasive use was associated with a longer length of hospital stay, in resource-limited healthcare systems. With the growing threat of antimicrobial resistance, surgical initiatives to implement antimicrobial stewardship programmes in low- and middle-income countries are critical.

View details for DOI 10.1093/bjs/znad438

View details for PubMedID 38198157