Non-indicated use of prophylactic antibiotics in gynaecological surgery at an academic tertiary medical centre

Abstract

Surgical site infections (SSI) are the most common surgical complication. Perioperative antibiotics can reduce SSI when used properly. Despite guidelines from The American College of Obstetrics and Gynecology, non-indicated antibiotic use is widespread which exposes women to unnecessary risks. This study represents a quality improvement analysis assessing surgeon compliance with established guidelines regarding antibiotic use in gynaecological surgery. This is a single centre, retrospective study examining gynaecological procedures over two years. Cases were identified using Current Procedure Terminology codes. Perioperative antibiotics were used contrary to published guidelines in 199 of 1046 cases. Three variables were independently associated with inappropriate administration of perioperative antibiotics: entrance into abdominal cavity, higher EBL, and longer procedures.

Impact statement

• Overuse of antibiotics has unintended consequences including allergic sequelae, extended length of hospital stay, increased healthcare costs, and the formation of antibiotic-resistant organisms.

• Antibiotic stewardship programmes have been shown to reduce the number of resistant pathogens, decrease incidence of Clostridium difficile colitis, and decrease length of hospital stay without increasing infection rates.

• Further outcomes-based research is needed regarding the use of antibiotic stewardship programmes in gynaecological surgery.

Keywords:

• Antibiotics
• gynaecological surgery
• general gynaecology
• prophylaxis
• quality improvement
• antibiotic resistance

Acknowledgements

The authors would like to acknowledge Dr John Joyce and Dr Wilma Larsen for their support and help in crafting the protocol for this project.

Disclosure statement

The authors report no declaration of interests.