Original Article

The compliance of surgical prophylactic antibiotics with standard protocols in Imam Reza teaching hospital of Birjand, Iran


Background and Objectives: Taking unnecessary or inappropriate prophylactic antibiotics can cause infections with resistant organisms. The present study aimed to investigate administration prophylactic antibiotics in surgery ward and its compliance with standard protocol in Imam Reza teaching hospital of Birjand, Iran.
Materials and Methods: This descriptive-analytical study was performed to evaluate the pattern of prophylactic antibiotics on patients who underwent surgical operations from October to December 2019. A checklist including demographic information, type of prophylactic antibiotics, dose and duration of using drug, type of surgery, and compliance with standard protocol was used. The validity and reliability of the checklist were evaluated and confirmed prior to the study. All eligible patients were enrolled and the information of the prescribed drugs in the surgical wards was compared with the Schwartz’s principles of surgery as standard protocol.
Results: Out of a total of 300 patients, 187 (62.3%) were male. Among the patients, 155 (51.7%) cases underwent general surgery, 119 (39.6%) cases orthopedic surgery, and 26 (8.7%) cases neurosurgery. The most popular prescribed antibiotics were cefazolin (170 cases) and ceftriaxone + metronidazole (67 cases). Furthermore, the maximum antibiotic administrations were two days (127 cases) and one day (93 cases). More importantly, 67.7% and 92.3% of the patients were in compliance with the standard protocol in terms of the type and time of administration, respectively.
Conclusion: Our results showed that duration and route of administrating antibiotics were consistent with the standard protocol, but the type of drugs and indication did not match.

1. Alexander JW. When should prophylactic antibiotics be given? Ann Surg 2009; 249: 557-558.
2. Lamme B, Boermeester MA, Reitsma JB, Mahler CW, Obertop H, Gouma DJ. Meta-analysis of relaparotomy for secondary peritonitis. Br J Surg 2002; 89: 1516-1524.
3. Kaye KS, Anderson DJ, Sloane R, Chen LF, Choi Y, Link K, et al. The effect of surgical site infection on older operative patients. J Am Geriatr Soc 2009; 57: 46-54.
4. Gouvêa M, Novaes Cde O, Pereira DM, Iglesias AC. Adherence to guidelines for surgical antibiotic prophylaxis: a review. Braz J Infect Dis 2015; 19: 517-524.
5. Lamb G, Phillips G, Charani E, Holmes A, Satta G. Antibiotic prescribing practices in general surgery: a mixed methods quality improvement project. Infect Prev Prac 2021; 3: 100166.
6. Tourmousoglou CE, Yiannakopoulou ECh, Kalapothaki V, Bramis J, St Papadopoulos J. Adherence to guidelines for antibiotic prophylaxis in general surgery: a critical appraisal. J Antimicrob Chemother 2008; 61: 214-218.
7. Rodríguez Sánchez F, Arteagoitia I, Teughels W, Rodríguez Andrés C, Quirynen M. Antibiotic dosage prescribed in oral implant surgery: A meta-analysis of cross-sectional surveys. PLoS One 2020; 15(8): e0236981.
8. Kaye KS, Sloane R, Sexton DJ, Schmader KA. Risk factors for surgical site infections in older people. J Am Geriatr Soc 2006; 54: 391-396.
9. Billoro BB, Nunemo MH, Gelan SE. Evaluation of antimicrobial prophylaxis use and rate of surgical site infection in surgical ward of Wachemo university Nigist Eleni Mohammed Memorial hospital, southern Ethiopia: prospective cohort study. BMC Infect Dis 2019; 19: 298.
10. Khan Z, Ahmed N, Rehman AU, Khan FU, Saqlain M, Martins MAP, et al. Audit of pre-operative antibiotic prophylaxis usage in elective surgical procedures in two teaching hospitals, Islamabad, Pakistan: An observational cross-sectional study. PLoS One 2020; 15(4): e0231188.
11. Karaali C, Emiroğlu M, Çalık B, Sert I, Kebapci E, Kaya T, et al. Evaluation of antibiotic prophylaxis and discharge prescriptions in the general surgery department. Cureus 2019; 11(6) :e4793.
12. Saxena S (2015). Microbes in production of fine chemicals (antibiotics, drugs, vitamins, and amino acids). In: Applied Microbiology. Springer, 1st ed. New Delhi, pp. 83-120.
13. Bulander RE, Dunn DL, Beilman GJ (2019). Surgical Infections. In: Schwartz's Principles of Surgery. Eds, F Brunicardi, DK Anderson, TR Billiar, DL Dunn, LS Kao, JG Hunter, JB Matthews, RE Pollock. McGraw-Hill, 11th ed. New York, pp. 157-181.
14. Mousavi S, Zamani E, Bahrami F. An audit of perioperative antimicrobial prophylaxis: compliance with the international guidelines. J Res Pharm Pract 2017; 6: 126-129.
15. Jimah T, Fenny AP, Ogunseitan OA. Antibiotics stewardship in Ghana: a cross-sectional study of public knowledge, attitudes, and practices among communities. One Health Outlook 2020; 2: 12.
16. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14: 73-156.
17. Gouvêa M, Novaes Cde O, Iglesias AC. Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle university hospital. Rev Col Bras Cir 2016; 43: 225-234.
18. Gladki A, Kaczanowski S, Szczesny P, Zielenkiewicz P. The evolutionary rate of antibacterial drug targets. BMC Bioinformatics 2013; 14: 36.
19. McGann P, Snesrud E, Maybank R, Corey B, Ong AC, Clifford R, et al. Escherichia coli harboring mcr-1 and bla CTX-M on a novel IncF plasmid: first report of mcr-1 in the United States. Antimicrob Agents Chemother 2016; 60: 4420-4421.
20. Sellars H, Boorman P. Acute appendicitis. Surgery (Oxford) 2017; 35: 432-438.
21. Lewis T, Cook J. Fluoroquinolones and tendinopathy: a guide for athletes and sports clinicians and a systematic review of the literature. J Athl Train 2014; 49: 422-427.
22. Blomberg M, Jensen MB, Henry A, Singh ST, Banipal RP, da Cunha-Bang C, et al. Antimicrobial drug use in a small Indian community hospital. Trop Doct 2010; 40: 194-198.
23. Rollins KE, Varadhan KK, Neal KR, Lobo DN. Antibiotics versus appendicectomy for the treatment of uncomplicated acute appendicitis: an updated meta-analysis of randomised controlled trials. World J Surg 2016; 40: 2305-2318.
24. Flowers CR, Seidenfeld J, Bow EJ, Karten C, Gleason C, Hawley DK, et al. Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American society of clinical oncology clinical practice guideline. J Clin Oncol 2013; 31: 794-810.
IssueVol 13 No 6 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v13i6.8082
Antibiotic prophylaxis; Guideline; Surgery; Compliance; Iran

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How to Cite
Ebrahimzadeh A, Najafi M, Bijari B, Amouzeshi A, Abedini MR, Mosavi T, Pagheh AS. The compliance of surgical prophylactic antibiotics with standard protocols in Imam Reza teaching hospital of Birjand, Iran. Iran J Microbiol. 2021;13(6):801-807.