Assessment of surgical antimicrobial prophylaxis in Orthopaedics and Traumatology Surgical Unit of a Tertiary Care Teaching Hospital in Addis Ababa

BACKGROUND: Prophylactic antimicrobials have a starring role in prevention of surgical site infection. This study assesses the practice of surgical antimicrobial prophylaxis (SAP) and development of surgical site infection (SSI) based on patient chart review in patients who underwent surgery in the Orthopaedics and Traumatology Surgical Unit of Tikur Anbesa Specialized Hospital (TASH). RESULTS: Majority of the patients 144 (72%) were males. 108 (54%) of the surgical wounds were clean and 63 (31%) were clean contaminated. 160 (80%) patients received preoperative prophylaxis, of these 153 (96%) received postoperative prophylaxis as well. 34 (17%) patients did not receive preoperative antimicrobial prophylaxis, while 6 (3%) patients had no record about preoperative antimicrobial prophylaxis. Among those who received preoperative antimicrobial prophylaxis the time of administration was not recorded in 87 (54%) of the patient charts and 36 (23%) patients had preoperative antimicrobial prophylaxis greater than 2 h prior to incision. Among the 188 (94%) patients that received postoperative antimicrobial prophylaxis; the duration of administration was more than 72 h in 114 (61%) patients, while only 8 (4%) received for less than 24 h after surgery. Ceftriaxone 309 (70%) was the most prescribed agent for prophylaxis. 32 (16%) patients developed surgical site of infection. Using odds ratio age equal to or above 50, clean contaminated and contaminated surgical wounds were not statistically associated with increased risk of SSI. CONCLUSION: Most patients who underwent surgery received prophylactic antimicrobials; nevertheless, the practice was not aligned with standard guidelines’ recommendations and patients developed surgical site infections.