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Benefit of a single preoperative dose of antibiotics in a Sub-Saharan district hospital: minimal input, massive impact

Abstract number: P829

Saxer F., Widmer A., Fehr J., Sooka I., Kibatala P., Urassa H., Mshinda H., Frei R., Smith T., Hatz C.

Objective: To evaluate the impact of a single shot preoperative antimicrobial prophylaxis in reducing the rate of surgical site infections (SSI) in an African hospital with very limited resources we implemented standardised guidelines with one dose of Amoxicillin/Clavulanic Acid within 2 hours prior incision.

Methods: In this rural district hospital in southern Tanzania an average of 150 surgical interventions is performed in two operating theatres every month. Ventilation is achieved by a defective air condition and open windows. Household soap is used for scrubbing.

Instruments are reprocessed by either heat (150°C for 1 h) or steam (134°C for 5min, temperature sensitive devices at 121 °C for 20min); a chemo-indicator is in use with every sterilisation process.

In a four month period in 2004, patients admitted for clean or clean-contaminated interventions had been included as pre-intervention group. The perioperative management differed depending on the surgeon. Patients admitted in the same setting in 2005 were enrolled as intervention group. They received one dose of 2.2g Augmentin® as intravenous infusion within 2 hours before incision. The substance was targeted at the bacteriologic pattern detected in SSIs of the pre-intervention group.

Patients were assessed daily and 30 days postoperative; in case of SSIs they received free diagnostic workup and treatment. Infections were identified according to the CDC classification; samples were analysed by Gram stain and agar (CHROMagar Orientation and CHROMagar S. aureus) in the local laboratory and the University Hospital Basel using standard methods. Data were reviewed by a senior infectious diseases specialist with full chart review.

Results: In the pre-intervention group 527 patients qualified for routine antimicrobial prophylaxis that was administered in 88% after incision and did not cover the expected pathogens to a large extent. One hundred and fourteen patients (21.6%) developed an SSI with 60% of detected pathogens being resistant to the administered antibiotics.

After implementation of the guidelines, the incidence of surgical site infections significantly decreased from 21.6% to 4% (11/276).

Conclusions: The implementation of a single shot antimicrobial prophylaxis dramatically decreased the rate of surgical site infections in a hospital with very limited resources. Such guidelines – though developed for industrialised countries – are even more effective in non-industrialised countries.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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