Practice of Prophylactic Antibiotic Use in Elective Orthopedic Procedures at the Kenyatta National Hospital

Abstract

Background: Orthopedic surgeries require the use of implants and these may cause an increased risk of infection. Surgical site infections are associated with high morbidity, death, and increased cost burden. The judicious use of prophylactic antibiotics following evidence-based guidelines leads to optimum outcomes, which includes reduced infection rate and also prevent antimicrobial resistance which is a rapidly progressing global crisis. Study objective: The practice of prophylactic antibiotic use in elective orthopedic procedures at level 6 Kenyatta National Referral Hospital. Design: Descriptive cross-sectional type of study. Study Area: Kenyatta National Hospital orthopedic inpatient wards and operating theaters. Methodology: Participants awaiting elective orthopedic surgery in KNH orthopedic wards were recruited using a consecutive sampling approach. Data collected from the patients in the operating room and wards included age, comorbidities, any allergies to antibiotics, alcohol and smoking history. Data was gathered from the treatment sheets and from antibiotic prescribers. Comparison to the available local guidelines was made and reasons for the choice of surgical antibiotic prophylaxis was sought from the prescribers. Data analysis: The collected data was analyzed using statistical package of social sciences version 24 and presented as tables, graphs and pie charts as appropriate. Bivariate analysis involving specific respondent characteristics on the variables of interest was used to perform tests of independence and association using Chi-square and T-test/ Analysis of Variance (ANOVA) respectively. All the statistical calculations were done at 95 percent confidence level and any statistic associated with a priori probabilities less than 5% were deemed statistically significant. Results: A total of 161 patients participated. Out of this patients Cefazolin was the most commonly used antibiotic 99% preoperatively and 86% post operatively. 87% of the antibiotics were given within one hour from start of operation and all antibiotics were given before application of tourniquet. varied dosages of antibiotics were given according to the ages. 16% of total operations used intraoperative vancomycin at wound site. The study showed spine and arthroplasty had the highest percent of use of vancomycin. 79% of the cases prolonged antibiotic were used. 19% of the prescribers post operatively did not have knowledge of KNH guidelines. the most common indication according to the prescribers for prolonged surgical antibiotic found in this study was due to preventing surgical site infection (33%) and case complexity (22%), other factors found were cefazolin being not available, surgeon’s preference, long duration and multiple procedures. Conclusion: There is an alarming high rate of prolonged surgical antibiotic prophylaxis despite this high rate of PSAP, the prescribing practices of antibiotics in terms of choice of drug, dosage, pre-operative timings were found mostly to be in line with the recommendations in the KNH guidelines