Surgical antimicrobial prophylaxis (SAP) plays an integral role in preventing surgical site infections (SSI), yet it is often inadequately implemented. A study looking into the link between the sufficiency of SAP and the occurrence of SSI and other nosocomial infections (NI) has offered valuable insights into areas that require improvement.
The study, both cross-sectional and retrospective, encompassed adult patients who underwent elective cardiovascular, orthopedic, colorectal surgeries, and cystectomy in 2022 at a teaching hospital. The study deemed SAP adequate if it followed all the criteria set forth by local guidelines including proper indication, drug selection, dose, timing, redosing, as well as the duration of administration.
From the 723 patients participated (average age 68 years; 57.7% male), almost all (98.8%) received SAP. Compliance with SAP guidelines was only 34.6% in all dimensions, with a high adherence observed for dosage (97.5%), regimen (92.8%), and timing (98.3%) but lower compliance for duration (53.9%) and redosing (63.4%). Remarkably, patients with beta-lactam allergies and those undergoing cystectomy showed lower adherence to regimen adequacy.
Inadequate SAP was connected with a higher rate of SSI, a length of hospital stay (LOS) exceeding 10 days, and a higher 90-day mortality rate. Patients who suffered from a SSI were significantly more likely to also experience other non-SSI NIs. Despite advancements in understanding and prevention, surgical site infections remain the second leading cause of healthcare-related infection across Europe. Prevailing issues with SAP span non-compliance with guidelines, incorrect timing of administration, and unnecessary prolongation, all resulting in an increased risk of SSI, prolonged LOS, and higher crude mortality rates.
In conclusion, the effective implementation of SAP is an area requiring improvement, particularly in the aspects of selecting a regimen, appropriate redosing, and restriction of SAP duration. Patients with beta-lactam allergies were particularly at risk of receiving inadequate SAP. These findings emphasize the need to address non-compliance with SAP guidelines to reduce infection rates, lower length of stay, and ultimately, save lives.
Source: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-025-01601-x