Antibiotic usage in surgical prophylaxis: surveillance of clean and clean-contaminated surgeries in a tertiary care hospital

BackgroundSurgical antibiotic prophylaxis (SAP) is an essential part of perioperative care, yet adherence to recommended practices varies across surgical categories. Differences in antibiotic choice and duration between clean and clean-contaminated procedures highlight the need to understand local prescribing patterns. This study aimed to describe SAP practices in a tertiary care hospital and assess adherence to institutional SAP guidelines in clean and clean-contaminated surgeries.MethodsA prospective observational cross-sectional study was conducted over 6 months in a tertiary care hospital. Adult patients undergoing elective clean or clean-contaminated surgeries were included. Information on perioperative antibiotic use was collected from medical records, and adherence to institutional prophylaxis guidelines was assessed. Data were analyzed using descriptive statistics, Chi-square or Fisher's exact tests, t-tests, relative risks, odds ratios, and multivariate logistic regression. A two-tailed p < 0.05 was considered statistically significant.ResultsA total of 170 patients were assessed, including 143 clean and 27 clean-contaminated surgical cases. Significant differences were observed in antibiotic selection between the two categories; cefuroxime was used more frequently in clean surgeries (50.3%) than in clean-contaminated procedures (25.9%), with a relative risk of 1.94 (95% CI 1.00–3.78; p = 0.037). Clean surgeries were associated with higher adherence to guideline-recommended prophylaxis, particularly for appropriate antibiotic choice (83.2 vs. 63.0%; p = 0.032) and appropriate duration (90.2 vs. 66.7%; p = 0.003). Overall appropriateness, measured using the Antibiotic Prophylaxis Appropriateness Index (APAI), was higher in clean surgeries (89.4%) compared with clean-contaminated procedures (76.3%; z = 2.98; p = 0.003). In multivariate analysis, clean-contaminated surgery (adjusted OR 3.89; 95% CI 1.37–11.05; p = 0.009) and prolonged prophylaxis duration (adjusted OR 4.61; 95% CI 1.74–12.18; p = 0.003) were independently associated with non-adherence. Surgical site infections were infrequent, with two cases (1.4%) reported in clean surgeries and none following clean-contaminated procedures.ConclusionAntibiotic prophylaxis practices varied between clean and clean-contaminated surgeries, with higher adherence observed in clean procedures, particularly in antibiotic selection and duration. Prolonged prophylaxis was more common in clean-contaminated surgeries and was associated with non-adherence. Given the observational design, causal inferences cannot be established. These findings highlight potential targets for improving guideline-based prophylaxis through antimicrobial stewardship strategies.