Optimizing Surgical Prophylaxis: An Audit of Antibiotic Use and Guideline Adherence in a Tertiary Care Hospital with Focus on Antimicrobial Stewardship

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Inappropriate antibiotic use, particularly in surgical prophylaxis, contributes to increasing antibiotic resistance and surgical site infections (SSIs). This study aimed to evaluate pre- and post-operative antibiotic prescribing practices and compliance with surgical prophylaxis guidelines in a tertiary care hospital, identifying areas for antimicrobial stewardship (AMS) intervention. A prospective study was conducted, collecting data on 250 surgical patients. After excluding 6 patients based on pre-defined criteria, data from 244 patients was analyzed using SPSS 20.0. The audit assessed patient demographics, pre- and post-operative antibiotic regimens, duration of antibiotic administration, and incidence of SSIs. Analysis revealed widespread use of broad-spectrum antibiotics for surgical prophylaxis, often deviating from established guidelines. Intravenous (IV) antibiotics were commonly administered for extended durations (24–72 hours) post-operatively. A significant proportion of patients (n=167) received oral antibiotics upon discharge to complete a 5-day course. The SSI incidence rate was 2.0%, with all infections occurring in patients who underwent open surgical procedures (laparotomies). Staphylococcus aureus was the most frequently isolated organism (including methicillin-resistant strains), followed by Klebsiella pneumoniae and Escherichia coli. Most isolates exhibited multidrug resistance, although they remained sensitive to antibiotics, such as vancomycin, linezolid, meropenem, and colistin. Management was guided by culture and sensitivity in most cases; however, one instance of irrational antibiotic use was observed. These findings emphasize the role of surgical type, duration, and appropriate microbial management in SSI prevention. In conclusion, the study highlighted significant deviations from surgical prophylaxis guidelines and irrational antibiotic use. The presence of multidrug-resistant organisms (MDROs) and inappropriate antibiotic selection further stressed the urgent need for targeted AMS interventions. These should include the development and implementation of hospital-specific prophylaxis protocols aligned with the best national or international practices. Ongoing monitoring is needed to assess AMS effectiveness.