Relationship between timing of surgical antimicrobial prophylaxis and surgical site infection in a tertiary-care hospital

Introduction: Antimicrobial prophylaxis before a surgical procedure can reduce the risk of surgical site infections (SSI). The literature suggests that the greater the lag period between the first dose of antimicrobial administration and surgical incision, the greater the chances of developing an SSI. Hence, appropriate timing of the administration of prophylactic antimicrobials is critical to maximize the benefits of prophylaxis. Objective: To examine the association between the timing of prophylactic antimicrobial administration and SSI rate in a tertiary-care hospital. Methodology: A total of 200 patients undergoing elective surgery from different surgical wards were included. Their detailed history, drug use especially that of antimicrobials, and surgical site were observed daily till discharge from the hospital. Odds ratios were calculated to examine the association between the timing of prophylactic antimicrobial use and the rate of SSIs. Results: In the total population of 200 patients, 63 patients (31.5 %) received their first prophylactic antimicrobial dose within 30 min before incision, with SSIs occurring in 6 of these patients (9.5 %); 133 patients (66.5 %) received a prophylactic antimicrobial >30 min before incision, with SSIs occurring in 29 (21.8 %); and the remaining 4 (2 %) patients did not receive preoperative antimicrobials prior to incision, with SSIs occurring in 3 patients (75 %). The odds ratio of developing an SSI in patients receiving their first dose of preoperative antimicrobial >30 min before incision relative to those receiving their first dose of preoperative antimicrobial within 30 min before incision is 2.65. Conclusion: This study examines the association between the timing of antimicrobial administration before surgery and the development of SSIs. Patients who received the antimicrobial dose too early before the procedure, including cases where the surgical procedure was delayed after the antimicrobial was administered, had an increased likelihood of an SSI. Efforts to improve the timing of antimicrobial administration are needed to decrease the SSI rate. © 2016, Springer International Publishing Switzerland.