Timing and Duration of Antibiotic usage in Appendectomies and Its Relation with Surgical Site Infection
[1]
Saadeldin Ahmed Idris, Faculty of Medicine, Department of Surgery, AlzaeimAlazhari University, Khartoum, Sudan.
[2]
Aamir Abdullahi Hamza, Faculty of Medicine, Department of Surgery, Bahri University, Khartoum, Sudan.
[3]
Abuobieda Omer Salih, Omdurman Teaching Hospital, Department of Surgery, Khartoum, Sudan.
[4]
Mohammed Eltayeb Adam Ali, Alneelain University, Faculty of Medicine, Khartoum, Sudan.
[5]
Mohamed Mahmoud Hafiz, Faculty of Medicine, Department of Surgery, AlzaeimAlazhari University, Khartoum, Sudan.
[6]
Kamal Elzaki Elsiddig, Faculty of Medicine, Department of Surgery, University of Khartoum, Khartoum, Sudan.
Background: Sepsis in modern surgery continues to be a significant problem for healthcare practitioners across the world. The proper use of resources is a critical challenge for health services. The optimal time for administration of preoperative doses is within 60 minutes before surgical incision. Short postoperative course of antimicrobials involving a single dose or continuation for less than 24 hours is the recommendation. Objectives: To evaluate the current timing practice and duration of antibiotic prophylaxis in patients underwent appendectomy. Patients and methods: A cohort study conducted in Omdurman teaching hospital (November 2011 to August 2012). It included all consecutive patients with appendicitis managed by appendectomy. Patients were followed up for one month and wound was assessed using ASEPSIS classification for presence of wound infection. The collected data was managed statistically using SPSS computer program version 21. Results: The study included 255 patients (192 (75.3%) males, 63 (24.7%) females) with male to female ratio of 3.1:1. Their mean age was 21.6 years (range 7 to 42 years). ASA I was recorded in 98.4%. Mean operative time was 42 minutes. Only 38.04% of patients received precisely timed prophylactic antibiotics. Incidence of surgical site infection (SSI) was 12.2%. According to ASEPSIS classification infection was minor, moderate, and severe in 19 (7.45%), 10 (3.92%) and 2.0 (0.78%) respectively. SSIs were developed in one to two weeks postoperatively in 93.5% of patients. Risk factors were such as smoking, diabetes mellitus or hypertension were studied and found to be statistically not significant p > 0.05. A higher incidence and statistically significant proportion of wound infections were developed in the group of patients that received antibiotics in either intra or postoperatively, p = 0.001.Conclusion: The most common violation of protocol is poor timing of the preoperative dose and prolonged duration of the prophylaxis.
Acute Appendicitis, Appendectomy, Postoperative Antibiotics, Prophylactic Antibiotics, Surgical Site Infections (SSIs)
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