Trends in the Use of Surgical Antibiotic Prophylaxis at a Provincial Hospital in Vietnam

Background: Surgical site infection (SSI) is one of the most significant causes of patient morbidity and mortality. Although antibiotic prophylaxis is crucial to the prevention of infection in different types of surgery, there is little evidence supporting the effectiveness of using prophylactic antibiotics at the hospital. Objective: The purpose of this study was to assess trends in the use of antibiotic prophylaxis for SSI prevention at the hospital. Methods: A retrospective study was performed at Nguyen Dinh Chieu Hospital using an analysis of all surgical records from January to September 2019. The analysis comprised 407 records that met all of the criteria. Data were collected according to socio-demographic characteristics, the clinical presentation of patients with surgical treatment, and trends in using surgical antibiotic prophylaxis. Results: Patients enrolled in the study had an average age of 35.2±14.4 years and over half were female (60.7%). Only 0.7% of patients were diagnosed with superficial incisional SSI and no patients were found to be infected with other types of SSI such as deep incisional SSI, organ/space SSI or remote infection. Of 2722 treatments with prophylactic antibiotics, the most common antibiotics used were Amoxicillin/Sulbactam (28.5%) and Metronidazole (27.6%). The majority of patients were given single antibiotic therapy (58.4%) and drugs were administrated via intravenous injection (60.7%). Most prophylactic antibiotics were prescribed at the usual dose and the first dose was usually administered within an hour after surgery (66.1%). Conclusion: The use of surgical antibiotic prophylaxis at the hospital was not based on the recommendations of clinical practice guidelines. Guidelines for the prevention of SSI should be strictly followed at the hospital.

1. World Health Organization. Global guidelines for the prevention of surgical site infection. World Health Organization; 2016.
2. Evrilia SR, Muhtadi A, Barliana MI, Winarni R. An evaluation of Ceftriaxone use in the antimicrobial stewardship program for surgical patients at a Hospital in Bandung. Journal of Advanced Pharmacy Education & Research| Jan-Mar. 2019;9(1).
3. Boyle KK, Rachala S, Nodzo SR. Centers for disease control and prevention 2017 guidelines for prevention of surgical site infections: review and relevant recommendations. Current reviews in musculoskeletal medicine. 2018 Sep 1;11(3):357-69.
4. Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, Abbas M, Atema JJ, Gans S, van Rijen M, Boermeester MA. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. The Lancet Infectious Diseases. 2016 Dec 1;16(12):e276-87.
5. Mawalla B, Mshana SE, Chalya PL, Imirzalioglu C, Mahalu W. Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania. BMC surgery. 2011 Dec;11(1):21.
6. Mu Y, Edwards JR, Horan TC, Berrios-Torres SI, Fridkin SK. Improving risk-adjusted measures of surgical site infection for the National Healthcare Safely Network. Infection Control & Hospital Epidemiology. 2011 Oct;32(10):970-8
7. Ling ML, Apisarnthanarak A, Madriaga G. The burden of healthcare-associated infections in Southeast Asia: a systematic literature review and meta-analysis. Clinical Infectious Diseases. 2015 Jun 1;60(11):1690-9.
8. Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, Keohane C, Denham CR, Bates DW. Health care–associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA internal medicine. 2013 Dec 9;173(22):2039-46.
9. De Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. American journal of infection control. 2009 Jun 1;37(5):387-97.
10. Warnock M, Ogonda L, Yew P, McIlvenny G. Antibiotic Prophylaxis Protocols and Surgical Site Infection Rates in Trauma Surgery: A Prospective Regional Study of 26,849 Procedures. The Ulster medical journal. 2019 May;88(2):111-4.
11. Boxma H, Broekhuizen T, Patka P, Oosting H. Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial. The Lancet. 1996 Apr 27;347(9009):1133-7.
12. AlOsaimi KM, Kambal AM, AlOtaibi FM, AL-Anazi AB, AlMotairi AR, AlGhamdi WM, Altujjar AR. Factors Affecting Physicians' Choice of Antibiotics for Treatment of Community Acquired Urinary Tract Infections and Their Correlation with Antimicrobial Susceptibility Test Results in King Khalid University Hospital during 2013-2014. International Journal of Pharmaceutical Research & Allied Sciences. 2018 Jan 1;7(1).
13. Bhandari MA, Vats N. ANTIBIOTIC PROPHYLAXIS FOLLOWING SIMPLE EXODONTIA: A CONTROLLED TRIAL. Annals of Dental Specialty Vol. 2019 Jan;7(1):1.
14. Nguyen Dinh Chieu Hospital, Introduction, Nguyen Dinh Chieu Hospital, [Online]. Available at http://bvndc.vn/lich-su-hinh-thanh. [Accessed: 05/10/2019].
15. Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, Bertran E, Jaber L. Diabetes and risk of surgical site infection: a systematic review and meta-analysis. infection control & hospital epidemiology. 2016 Jan;37(1):88-99.
16. Koigi-Kamau R, Kabare LW, Wanyoike-Gichuhi J. Incidence of wound infection after caesarean delivery in a district hospital in central Kenya. East African medical journal. 2005 Jul;82(7):357-61.
17. Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged operative duration increases risk of surgical site infections: a systematic review. Surgical infections. 2017 Aug 1;18(6):722-35.
18. Altemeier A. Definitions and classifications of surgical infections. Manual on control of infection in surgical patients. 1984;1:19-30.
19. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surgical infections. 2013 Feb 1;14(1):73-156.
20. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infection Control & Hospital Epidemiology. 1999 Apr;20(4):247-80.
21. de Jonge SW, Gans SL, Atema JJ, Solomkin JS, Dellinger PE, Boermeester MA. Timing of preoperative antibiotic prophylaxis in 54,552 patients and the risk of surgical site infection: A systematic review and meta-analysis. Medicine. 2017 Jul;96(29):e6903.