Misuse of prophylactic antibiotics and prevalence of postoperative wound infection in obstetrics and gynecology department in a Sudanese hospital

Abstract

Purpose: This study was conducted to auditprophylactic antibiotic use and to quantify the rate of wound infection. Methods:Across-sectional prospective study was conducted in the Obstetrics andGynecology Department in Khartoum Teaching Hospital, Sudan during March 1stto 31st October 2010. All Patients (aged >18 years) were included. Results:Overall 725 patients were included. The performed surgical procedures were 751;of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was7.8%. The rate of wound infection among patients operated on for caesarean sectionand abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariatelogistic analysis showed that body mass index [BMI] ≥ 30 kg/m2 OR2.1, 95% CI (1.1 - 4.0), (P = 0.019) was the major independent risk factor foroccurrence of wound infection. Evaluation of prescriptions’ parameters against thestated criteria showed that 113 (15.8%) patients were given antibiotics withadequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%)received the first preoperative dose/s in a proper time window, and 716 (100%)had prophylaxis for extended duration. Overall conformity to the stated criteriafor the evaluation of prescription’s parameters was not achieved in allprescriptions. Conclusions: In this setting, antibiotics were irrationally usedand wound infection rate was high, and the situation calls for multipleinterventions to correct the situation, through the activation of the infectioncontrol committee in the hospital and development of antimicrobial subcommitteeto develop policies for the use and auditing of prophylactic antibiotics.