Surgical Site Infection and its Relation with Prophylactic Antibiotics Prescription Pattern in a Tertiary Care Hospital of North India

  • Mohammad Tariq Salman Department of Pharmacology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, Saudi Arabia.
  • Athar Ali Department of Physiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. 202002. India.
  • Md. Iftakhar Department of Pharmacology, KMCT Medical College, Manasserry, PO Mukkam, Calicut 673602. India.
  • Sartaj Wali Khan Department of Surgery, Career Medical College, IIM Road, Lucknow. India.
Keywords: Antibiotic Prophylaxis; Anti-Infective Agents; Digestive System Surgical Procedures; Drug Prescriptions; Drug Utilization; Inappropriate Prescribing; Surgical Wound Infection


Background: Contribution of antibiotic prophylaxis in reducing surgical site infection for some procedures is well known. In spite of knowledge about the effectiveness of antibiotic prophylaxis, its administrative regimens are often inappropriate.

Objectives: To study the pattern of use of preoperative prophylactic antibiotic and its relationship with surgical site infection (SSI) in a tertiary care teaching Hospital.

Methods Hundred case records files of patients admitted in surgical wards of Jawaharlal Nehru Medical College, Aligarh who had undergone open bowel surgery, were randomly selected from the Central Record Section and analyzed for prescription pattern for prophylactic antibiotics according to World Health Organization prescribing indicators for number of antibiotics, antibiotics prescribed by generic name and antibiotics prescribed from ‘Essential Medicines’ List per encounter. Cost of antibiotics, commonly prescribed antibiotics and timing of administration were also studied. Patients who developed surgical site infection and those who did not were compared statistically.

Results: Commonly administered antibiotics were Ceftriaxone, Metronidazole and Amikacin given intravenously just before surgery. No relationship was seen between patient’s age, type of surgery or site of disease and choice of antibiotics. No drug was prescribed by generic name. Total cost on antibiotics was Indian Rupees 73.1 to 218.0. Surgical site infection developed in 40 patients. No significant relationship found between administration of any antibiotics or their cost and development of surgical site infection. High degree of resistance to Fluoroquinolones followed by second and third generation Cephalosporins was found in infecting organisms.

Conclusions: Prescribing pattern was not based on World Health Organization criteria for rational use of drugs and not evidence based. This study indicates the need for interventions to improve rational use of antibiotic prophylaxis in India.


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1. Gouvêa, Marise, Novaes, Cristiane de Oliveira, Pereira, Daniele Masterson Tavares, & Iglesias, Antonio Carlos. (2015). Adherence to guidelines for surgical antibiotic prophylaxis: a review. Brazilian Journal of Infectious Diseases, 19(5), 517-524.
2. Burke JP. Patient safety: infection control – a problem for patient safety. N Engl J Med 2003; 348:651–6.
3. Gagliardi AR, Fenech D, Eskicioglu C, Nathens AB, MacLeod R. Factors influencing antibiotic prophylaxis for surgical site infection prevention in general surgery: a review of literature. Can J Surg 2009; 52(6):481-9.
4. Delgado-Rodriguez M, Sillero-Arenas, Medina-Cuadros M, Martinez-Gallego G. Nosocomial infections in surgical patients: comparison of two measures of intrinsic patient risk. Infect Control Hosp Epidemiol 1997; 18:19–23.
5. Gupta D, Gupta AK. Prescribing Pattern of Antimicrobial Agents in Pelvic Inflammatory Disease – A Hospital Based Prospective Study. Int Arch BioMed Clin Res. 2017;3(2):111-114.DOI:10.21276/iabcr.2017.3.2.25.
6. Salman MT, Khan FA, Rahman SZ, Makhdoom M. Drug Prescribing Pattern in Dental Teaching Hospital. JK Science. 2009; 11 (2): 107
7. Burke JP. Maximizing appropriate antibiotic prophylaxis for surgical patients: an update from LDS Hospital, Salt Lake City. Clin Infect Dis 2001; 33(Suppl 2):S78–83.
8. Martin C. Antimicrobial prophylaxis in surgery: general concepts and clinical guidelines. French Study Group on Antimicrobial Prophylaxis in Surgery, French Society of Anesthesia and Intensive Care. Infect Control Hosp Epidemiol 1994; 15:463–71.
9. Vazquez-Aragon P, Lizan-Garcia M, Cascales-Sanchez P,Villar-Canovas MT, Garcia-Olmo D. Nosocomial infection and related risk factors in a general surgery service: a prospective study. J Infect 2003; 46:17–22.
10. Dale W. Bratzler, Peter M. Houck, Chesley Richards, Lynn Steele, E. Patchen Dellinger, Donald E. Fry, et al. Use of Antimicrobial Prophylaxis for Major Surgery: Baseline Results From the National Surgical Infection Prevention Project. Arch Surg. 2005; 140(2):174-182.
11. Polk HC Jr, Trachtenberg L, Finn MP. Antibiotic activity in surgical incisions. The basis of prophylaxis in selected operations. JAMA 1980; 244:1353–4.
12. Gregory de Lissovoy, Kathy Fraeman, Valerie Hutchins, Denise Murphy, David Song, Brian B. Vaughn. Surgical site infection: Incidence and impact on hospital utilization and treatment costs. American Journal of Infection Control 2009; 37:387-397.
13. Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther 1999; 41:75-80.
14. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999; 27:97–132.
15. Parulekar L, Soman R, Singhal T, Rodrigues C, Dastur FD, Mehta A. How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study. Indian Journal of Surgery. 71 (1) 2009. 15-18.
16. Mangram AJ, Horan TC, Pearson ML, Silver LS, Jarvis WE. Guideline for Prevention of Surgical Site Infection 1999. Infect Control Hosp Epidemiol 20:247–280.
17. World Health Organization. Prevention of hospital-acquired infections. A practical guide 2nd edition. WHO/CDS/CSR/EPH/2002.12.
18. International Statistical Classification of Diseases and Related Health Problems 10th Revision. ICD-10 Version:2015. World Health Organization. Available at (last accessed 15/01/2018)
19. Implementing a drug use indicators study. Trainers’ guide. Available at
DU_Course/Trainers_Guides/7_implementingtg.doc (last accessed: 15/01/2018).
20. WHO Model List of Essential Medicines. 18th edition (April 2013) available at Last accessed on 15/01/2018.
21. Esposito S. Immune system and surgical site infection. J Chemother. 2001, 13:1(1):12-6.
22. Kaye KS, Achnit K, Pieper C, Sloane R, Caughkan KF, Sexton DJ, et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis. 2005; 191(7):1056-62.
23. Sangrasi AK, Leghari AA, Memon A, Talpur AK, Qureshi GA, Memon JM. Surgical site infection rate and associated risk factors in elective general surgery at a public sector medical university in Pakistan. Int Wound J. 2008 Mar; 5(1):74-78.
24. Raka L, Krasniqi A, Hoxha F, Musa R, Mulliqi G, Krasniqi S, et al. Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital. J Infect Dev Ctries. 2007; 1(3):337-41.
25. Garcia-Vazquez E, Fernández Lobato B, Pareja A, Gómez J, de la Rubia A. Pharmacoeconomic results of introducing antimicrobial prophylaxis in surgery at a university hospital. Cir Esp. 2008 Dec; 84(6):333-6.
26. Sohn AH, Parvez FM, Vu T, Hai HH, Bich NN, Le Thu TA, et al. Prevalence of surgical-site infections and patterns of antimicrobial use in a tertiary care hospital in Ho Chi Minh City, Vietnam. Infect Control Hosp Epidemiol. 2002 Jul; 23(7):382-7.
27. LeMire M, Wing L, Gordon DL. An audit of third generation cephalosporin prescribing in a tertiary care hospital. Aust N Z J Med. 1996 Jun; 26(3):386-90.
28. Shanker PR, Upadhyay DK, Subish P, Bhandari RB, Das B. Drug utilisation among older inpatients in a teaching hospital in Western Nepal. Singapore Med J. 2010 Jan; 51(1):28-34.
29. Ghimire S, Nepal S, Bhandari S, Nepal P, Palaian S. A prospective surveillance of drug prescribing and dispensing in a teaching hospital in western Nepal. J Pak Med Assoc. 2009; 59(10):726-31.
30. Akande TM, Ologe MO.Prescription pattern at a secondary health care facility in Ilorin, Nigeria. Ann Afr Med. 2007; 6(4):186-9.
31. Woods Rk, Dellinger Ep. Current Guideline for Antibiotic Prophylaxis of Surgical Wounds. American Family Physician. 1998. 57:2731-2742.
32. Shinagawa N, Yokoyama T, Takeyama H, Taniguchi M, Mikamo H, Yura J. Fundamental study on the selection of antimicrobial prophylactic agents in abdominal surgery. Jpn J Antibiot. 2007; 60(4):189-99.
33. Vyhnanek F, Duchác V, Skála P, Teplan V Jr. Surgical site infection following proximal GIT procedures. Rozhl Chir. 2008; 87(6):297-300.
34. Kaya E, Yetim I, Dervisoglu A, Sunbul M, Bek Y. Risk factors for and effect of one-year surveillance program on surgical site infection at a university hospital in Turkey. Surg Infect (Larchmt). 2006; 7(6):519-26.
35. Fajardo Rodríguez HA, Quemba Gordillo J, Eslava Schmalbach J. Prediction scales and infection on surgical sites in 15625 surgeries. 2001-2003. Rev Salud Publica (Bogota). 2005 Jan-Apr;7(1):89-98.
36. Furukawa K, Onda M, Suzuki H, Maruyama H, Akiya Y, Ashikari M, et al. The usefulness of conducting investigations on intra-abdominal bacterial contamination in digestive tract operations. Surg Today. 1999; 29(8):701-6.
37. Shinagawa N, Yokoyama T, Takeyama H, Taniguchi M, Mikamo H, Yura J. Fundamental study on the selection of antimicrobial prophylactic agents in abdominal surgery. Jpn J Antibiot. 2007 Aug; 60(4):189-99.
38. Arnold FW, McDonald LC, Smith RS, Newman D, Ramirez JA. Improving antimicrobial use in the hospital setting by providing usage feedback to prescribing physicians. Infect Control Hosp Epidemiol. 2006; 27(4):378-82.
39. Willems L, Simoens S, Laekeman G. Follow-up of antibiotic prophylaxis: impact on compliance with guidelines and financial outcomes. J Hosp Infect. 2005 Aug; 60 (4): 333-9.
40. Gagliardi AR, Fenech D, Eskicioglu C, Nathens AB, MacLeod R. Factors influencing antibiotic prophylaxis for surgical site infection prevention in general surgery: a review of literature. Can J Surg 2009. 52(6):481-9.
How to Cite
Salman MT, Ali A, Iftakhar M, Khan SW. Surgical Site Infection and its Relation with Prophylactic Antibiotics Prescription Pattern in a Tertiary Care Hospital of North India. Int Arch BioMed Clin Res [Internet]. 2018Mar.21 [cited 2022Sep.30];4(1):152-6. Available from: