An audit of prophylactic surgical antibiotic use in a Sudanese Teaching Hospital

Background Antibiotic prophylaxis is effective at reducing the risk of postoperative infection for nearly all types of surgery. Objective To audit the use of prophylactic antibiotics for elective surgery. Setting Khartoum Teaching Hospital, Sudan, a 1,000 bed tertiary level hospital. Method A prospective study was conducted over a 9 month period; patients admitted for elective surgery were included consecutively. Main outcome measure The use and administration of prophylactic antibiotics for elective surgery. Results A total of 1,768 patients with mean age 37.8 ± 14 years were recruited (females, 83.3 % of total) who underwent 1,814 surgical interventions. Of these 1,277 (70.4 %) of procedures were clean-contaminated. A total of 1,758 patients (99.4 % of total) received antibiotics for prophylaxis; 1,730 patients (97.9 %) were given antibiotics in the operating room; for 1,288 (74.5 %) of cases the antibiotics were considered ‘recommended’, while for 442 (25.5 %) they were not. Out of the patients for whom prophylaxis was recommended and was given, 725 (56.3 %) of patients received a broad spectrum antibiotic or unnecessary combination, 913 (70.9 %) received a sub-therapeutic dose, 120 (9.3 %) were given the first preoperative dose within the proper time window, and 1,250 (97 %) of patients had an extended duration of prophylaxis. Compliance with all stated criteria was achieved in only 47 (2.7 %) of observed prescriptions. Conclusion This audit showed a wide gap between international standards and local practices; the authors call for urgent action to correct this situation through the development and implementation of local clinical guidelines.