Effectiveness Of Preoperative Antibiotic Prophylaxis Timing in Reducing Surgical Site Infections: A Prospective Observational Study
DOI:
https://doi.org/10.63682/jns.v13i1.8589Keywords:
Surgical site infection, antibiotic prophylaxis, timing, prospective studyAbstract
Background: Surgical site infections (SSIs) remain a significant cause of postoperative morbidity, increased healthcare costs, and prolonged hospital stays despite advances in surgical techniques and antimicrobial therapy. The timing of preoperative antibiotic prophylaxis administration has been identified as a critical factor in SSI prevention, yet optimal timing parameters remain debated. This study aimed to evaluate the effectiveness of different preoperative antibiotic prophylaxis timing intervals in reducing SSIs across various surgical procedures.
Methods: A prospective observational study was conducted at a tertiary care teaching hospital from January 2023 to December 2023. We enrolled 450 patients undergoing clean and clean-contaminated surgeries who received prophylactic antibiotics. Patients were categorized into three groups based on antibiotic administration timing: Group A (120-60 minutes before incision), Group B (60-30 minutes before incision), and Group C (30-0 minutes before incision). Patient demographics, comorbidities, surgical characteristics, timing of antibiotic administration, and development of SSI within 30 days post-surgery were recorded. Statistical analysis was performed using chi-square tests and multivariate logistic regression to identify significant associations.
Results: The overall SSI rate was 7.6% (34/450 patients). SSI rates by timing group were: Group A (120-60 minutes) 12.1%, Group B (60-30 minutes) 4.2%, and Group C (30-0 minutes) 6.8%. Multivariate analysis revealed that antibiotic administration 60-30 minutes before incision was associated with significantly lower SSI rates compared to other timing intervals (adjusted OR 0.38, 95% CI 0.21-0.67, p=0.001). Additional independent risk factors for SSI included diabetes mellitus, prolonged operative time (>2 hours), emergency surgeries, and higher ASA scores.
Conclusion: This study demonstrates that optimal timing of preoperative antibiotic prophylaxis is 60-30 minutes before surgical incision. Implementation of standardized protocols emphasizing this timing window could significantly reduce SSI rates. Hospital antimicrobial stewardship programs should focus on this timing parameter as a key quality improvement measure
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Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198-208.
Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 Update. Infect Control Hosp Epidemiol. 2014;35(6):605-27.
World Health Organization. Global guidelines for the prevention of surgical site infection. 2nd ed. Geneva: World Health Organization; 2018.
Berrios-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784-91.
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. Am J Infect Control. 2009;37(5):387-97.
Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017;224(1):59-74.
Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70 Suppl 2:3-10.
Reichman DE, Greenberg JA. Reducing surgical site infections: a review. Rev Obstet Gynecol. 2009;2(4):212-21.
Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged operative duration increases risk of surgical site infections: a systematic review. Surg Infect. 2017;18(6):722-35.
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283.
Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery. 1961;50:161-8.
Bratzler DW, Houck PM; Surgical Infection Prevention Guidelines Writers Workgroup. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38(12):1706-15.
World Health Organization. Summary of a systematic review on optimal timing for preoperative surgical antibiotic prophylaxis. In: Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization; 2018.
Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992;326(5):281-6.
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 (Baltimore). 2017;96(29):e6903.
de Jonge SW, Boldingh QJJ, Koch AH, Daniels L, de Vries EN, Spijkerman IJB, et al. Timing of Preoperative Antibiotic Prophylaxis and Surgical Site Infection: TAPAS, An Observational Cohort Study. Ann Surg. 2021;274(4):e308-e314.
Sattar R, Marshall R, Wong KY, Scott LJ, Robinson A, Ahmed A, et al. The Ideal Time to Administer Pre-operative Antibiotics: Current and Future Practices. Cureus. 2021;13(8):e17501.
Thampi N, Guzman-Cottrill J, Bartlett AH, Berg W, Cantey JB, Kitt E, et al. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2023;44(5):793-839.
Heinz J, Walshaw J, Kwan JY, Long J, Carradice D, Totty J, et al. PRESS survey: PREvention of surgical site infection—a global pan-specialty survey of practice protocol. Front Surg. 2023;10:1251444.
Sharma G, Sharma S, Thakur K, Gupta A, Kalsi D, Jaswal KK. Surgical site infection in a tertiary care center in North India: A prospective study. Indian J Med Microbiol. 2019;37(3):383-8.
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