Antimicrobial Prophylaxis in General Surgery: Evaluating Practice Patterns and Surgical Site Infection Outcomes

Abstract

Surgical site infections (SSIs) are defined by the Centers for Disease Control and Prevention (CDC) as infections that arise within 30 days following a surgical procedure [16]. Based on the extent of contamination, surgical wounds are classified as clean, clean-contaminated, contaminated, or dirty [3]. In low- and middle-income countries (LMICs), SSIs represent the most common form of healthcare-associated infections (HAIs), affecting nearly 10% of surgical patients. Although SSIs are the leading cause of HAIs in surgical wards, they rank as the second most common HAI overall, accounting for approximately 14% to 16% of all hospitalized patients and 23% to 38% of those undergoing surgery [2].

Evidence suggests that the ideal timing for the administration of prophylactic antibiotics is at least 30 minutes and not more than 60 minutes before making the surgical incision [17]. Despite progress in surgical techniques and our understanding of the pathogenesis of wound infections, SSIs remain a significant burden for healthcare systems. Timely initiation of antimicrobial prophylaxis—prior to potential microbial exposure—is essential to curb bacterial proliferation and reduce the incidence of SSIs.It is estimated that up to 60% of SSIs can be prevented through adherence to evidence-based practices, particularly regarding the appropriate timing, selection, and duration of antibiotic prophylaxis. In clinical practice, antibiotics are frequently prescribed for both infection prevention and treatment in surgical settings [2]. Notably, 30% to 50% of hospital-prescribed antimicrobials are used for surgical prophylaxis, and among these, inappropriate use has been reported to range from 30% to 90% [18,19]. The overuse of antimicrobial agents under the pretext of infection prevention remains a critical issue in surgical antimicrobial prophylaxis (SAP).The improper use of antimicrobials not only fails to reduce infection rates but also contributes to antimicrobial resistance, adverse drug events, and complications such as Clostridium difficile infections and acute kidney injury [20]. Therefore, SAP must be optimized across all perioperative stages—before, during, and after surgery. Numerous studies have highlighted frequent deviations from clinical guidelines, including the selection of antimicrobials not aligned with national or institutional protocols [20]. These inconsistencies may stem from factors such as medication shortages, skepticism toward local guidelines, institutional policies, personal clinical preferences, or regional resistance patterns.Research suggests that up to 55% of SSIs can be avoided through consistent implementation of validated preventive strategies [20]. The present study aims to evaluate the patterns of antimicrobial use in surgical prophylaxis at a tertiary care center in central India and assess their association with surgical site infection outcomes.