To Compare the Effectiveness of Short‑term Three Dose Perioperative Antibiotic Coverage during Decisive Period with Conventional Prolonged Postoperative Antibiotic Usage in Clean Elective Surgical Cases: An Indian Perspective

Abstract

Background: Surgical site infections are the most common postoperative complications and frequently cause morbidity and mortality. Different antibiotic regimens were evaluated as prophylaxis in wound infection following elective surgical procedures. Prophylactic antibiotics should be given to cover the “decisive period” which is a period after incision to mobilization of host defenses thus preventing an infection from developing. Objectives: The aim is to study the effectiveness of short‑term antibiotic coverage during decisive period in the prevention of postoperative wound sepsis in clean surgical cases. Materials and Methods: The prospective randomized comparative study included 50 patients divided into two groups of 25 each. Group A (short‑term ceftriaxone prophylaxis) patients received three doses of 1 g intravenous ceftriaxone. First dose 12 h, 2nd dose 1 h before operation and the 3rd dose was given 10 h after the operation. The Group B (conventional postoperative ceftriaxone prophylaxis) patients received postoperatively 1 g B. D intravenous ceftriaxone for 5 days. We compared the incidence of surgical site infection in two groups. Study Period: November 2014 to September 2016. A predesigned and pretested proforma was used to collect the data. Surgical sites were examined for 30 days. Robertson grading was used to assess the severity of infection. Results: Surgical site infection rate was 4% in Group A and 24% in Group B. The severity of infection was less in short‑term prophylaxis group. Anemia, nutritional status, and use of drain were other factors associated with postoperative wound infections. Conclusion: Short course perioperative (three doses) ceftriaxone prophylaxis is sufficient in preventing wound infection. Prophylactic antibiotic should be given to cover the decisive period to prevent an infection from developing. The judicious use of antibiotics can reduce the cost, unnecessary prolonged exposure, side effects, and the emergence of resistant micro‑organisms.

Keywords: Ceftriaxone, clean wound, perioperative, surgical site infection