Use of surgical antibiotic prophylaxis and the prevalence and risk factors associated with surgical site infection in a tertiary hospital in Malaysia

Introduction Surgical antibiotic prophylaxis (SAP) is effective in reducing surgical site infections (SSIs). However, inappropriate use of SAP increases the risk of SSIs and antibiotic resistance. Objectives To evaluate the rate of compliance with timing and duration of SAP and to evaluate the prevalence and risk factors associated with SSIs. Method This retrospective study was conducted among surgical patients in a tertiary hospital in Malaysia from June to August 2019. Patients' electronic medical records were reviewed for data collection and the data were analysed using both descriptive and inferential analyses. Results This analysis included 127 surgical procedures in patients with a mean age of 43.4 +/- 22.3 years and a male preponderance (64%). Only 37.8% received pre-operative SAP, with metronidazole (27.4%), amoxicillin-clavulanic acid (25.8%) and cefoperazone (22.6%) being the most common antibiotics. Overall, the timing of SAP was inappropriate in 92.1% of the procedures. Approximately 59% received SAP for more than 24 h. Those who received pre-operative antibiotics were less likely to receive SAP beyond 24 h (odds ratio (OR): 0.219; 95% confidence interval (CI) 0.082-0.588; p = 0.003). The prevalence of SSI was 16.5% and was associated with the length of hospital stay after surgery (OR: 1.144; 95 CI 1.035-1.265; p = 0.008) and duration of surgery (OR: 1.006; 95% CI 1.000-1.012; p = 0.038), but these significances disappeared in a multivariate analysis. Conclusion Inappropriate use of SAP was observed including late administration and long duration of antibiotic use. The prevalence of SSIs is high and is associated with duration of surgery and length of hospital stay after surgery. Pre-operative SAP may reduce treatment duration. Antimicrobial stewardship intervention is recommended and infection control strategies should be strengthened.