Surgical antibiotic prophylaxis (SAP) is a vital intervention aimed at mitigating the risk of post-operative infectious complications, its proper application leading to a notable decrease in surgical site infection rates. However, improper use of SAP can lead to a range of negative implications, including unnecessary expenditure, detrimental events, normalized microbiota disruption, and most concerningly, an increased global burden of antimicrobial resistance (AMR).
Our study sought to assess the level of adherence to SAP guidelines, and identify the contributing factors to non-compliance within Ain Shams University Hospital’s Department of Obstetrics and Gynaecology. This investigation was conducted through a combination of a cross-sectional survey and qualitative research using an online focus group of eight participants. It screened 280 surgical procedures performed from November to December 2024, analysing variables such as the prescribed antibiotic, timing of administration, and the duration of use.
The results evidenced an alarming finding: full compliance with SAP guidelines was not witnessed in any of the scrutinised cases. Of these, 62.5% were prescribed an appropriate antibiotic, but only 38.2% adhered to the recommended 60-minute pre-incision administration window, while a mere 6.1% observed the advised single-dose or ≤ 24-hour post-operative regimen.
Upon further examination of the findings, several barriers to conformity were identified, including knowledge gaps, operational inefficiencies, insufficient monitoring procedures, limited availability of antibiotics, financial limitations, and lax enforcement of established SAP guidelines. Therefore, it’s clear that institutional efforts to address these systemic barriers and enforce policy adherence are essential to enhancing antibiotic stewardship in surgical settings.
Further, tailoring of antibiogram-based prophylaxis, close clinical and microbiological surveillance, educational programs for surgeons and residents, and implementation of antimicrobial stewardship programs would likely aid to improving adherence to guidelines and patient outcomes. Recognizing this will allow infection prevention professionals and hospital management teams to address factors contributing to non-compliance and create more effective strategies to ensure adherence to SAP guidelines.
Source: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-025-01607-5