Antibiotic Prophylaxis Practices in Orthopedic Surgeries: A Public Health Audit of Guideline Adherence
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Background: Surgical antibiotic prophylaxis is essential in preventing surgical site infections (SSI) in orthopedic procedures; however, inappropriate use may reduce effectiveness and contribute to antimicrobial resistance. Objective: To assess adherence to antibiotic prophylaxis guidelines in orthopedic surgeries and examine its association with postoperative infections. Methods: A clinical audit was conducted over six months in a tertiary care hospital in Faisalabad, Pakistan, including 148 adult patients undergoing orthopedic surgery. Data on antibiotic choice, timing, dose, route, and duration were collected and compared with international guidelines. SSI occurrence and microbiological findings were analyzed. Statistical analysis included descriptive measures and comparative tests with odds ratios and 95% confidence intervals. Results: Full guideline adherence was observed in 24.3% of cases. Correct timing was achieved in 58.1%, and correct duration in 29.1%. Ceftriaxone was the most commonly used antibiotic (48.0%), while cefazolin was used in 15.5% of cases. The overall SSI rate was 8.8%, with lower incidence in the adherent group (2.8%) compared to the non-adherent group (10.7%) (OR 4.17; 95% CI 0.52–33.3; p=0.18). Prolonged postoperative antibiotic use was the most frequent deviation. Conclusion: Antibiotic prophylaxis practices showed low adherence to standard guidelines, particularly in timing and duration. Improved stewardship and protocol-based interventions are needed to optimize antibiotic use and reduce SSI risk
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