Role of Prophylactic Antibiotics in Preventing Surgical Site Infections
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Abstract
Background: Surgical site infection remains a common postoperative complication after clean-contaminated surgery and contributes to prolonged hospital stay, additional antibiotic exposure, increased healthcare cost, and delayed recovery. Prophylactic antibiotics are effective when administered at the correct time and discontinued appropriately, but routine practice often includes delayed administration and unnecessary postoperative continuation. Objective: To evaluate whether implementation of a structured prophylactic antibiotic protocol was associated with reduced 30-day surgical site infection among patients undergoing clean-contaminated surgery. Methods: This prospective before-and-after quasi-experimental study was conducted in a tertiary care hospital in Islamabad, Pakistan. A total of 220 adult patients undergoing clean-contaminated elective or semi-elective surgery were included, with 110 patients observed during routine practice and 110 managed after implementation of a structured prophylaxis protocol. The intervention emphasized antibiotic administration within 60 minutes before incision and avoidance of routine postoperative antibiotics unless clinically indicated. Patients were followed during admission and up to 30 days after surgery. Results: Timely antibiotic administration improved from 58.2% to 93.6%, while unnecessary postoperative antibiotic continuation decreased from 62.7% to 21.8%. Total surgical site infection decreased from 16.4% in the routine-practice group to 6.4% in the structured-prophylaxis group, corresponding to a 10.0 percentage-point absolute risk reduction, relative risk of 0.39, and approximate number needed to treat of 10. Most infections were superficial incisional infections. Conclusion: Structured prophylactic antibiotic implementation was associated with better timing compliance, reduced unnecessary postoperative antibiotic use, and lower 30-day surgical site infection in clean-contaminated surgery.
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