Characterization of surgical antimicrobial prophylaxis in a General Surgery Service
Keywords:
antibiotic prophylaxis, general surgery, emergency treatment, CubaAbstract
Introduction: Inappropriate use of surgical antimicrobial prophylaxis increases antimicrobial resistance and surgical site infections. The lack of standardized national guidelines for adults requires monitoring their implementation.
Objective: To characterize surgical antimicrobial prophylaxis in the general surgery service of General Teaching Hospital Iván Portuondo.
Methods: An observational, descriptive, cross-sectional study (medication use, indication-prescription type) was conducted from February to August 2021 in a population of 438 patients. Variables studied included the indication for prophylaxis, antimicrobial used, choice of antimicrobial, start of administration, dose, number of doses, and duration of prophylaxis. Statistical processing and analysis were descriptive.
Results: 83% of indications were inappropriate, mainly in contaminated (45.9%) and dirty (34.2%) surgeries. The most commonly used antimicrobials were metronidazole (52.3%) and cefazolin (28.1%), with inappropriate choice in 55% of cases. In 79.7% of surgeries, prophylaxis lasted more than 24 hours. 92.3% of antimicrobials were administered within 30-60 minutes before surgery, with dosage errors, and administration in three or more doses predominated.
Conclusions: Surgical antimicrobial prophylaxis was characterized by its predominant application in emergency contexts, such as the treatment of acute appendicitis with frequently inappropriate antimicrobial selection—especially in contaminated and dirty procedures—where metronidazole stands out as a recurrent choice. It usually begins in the recommended pre-surgical period, but it continues for more than 24 hours, with appropriate doses in most cases.
Downloads
References
1. Camacho Silvas LA. Resistencia bacteriana, una crisis actual. Rev Esp Salud Pública [Internet]. 2023 [citado 20/12/2024];97:e202302013. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10541255/
2. Organización Mundial de la Salud. Resistencia a los antimicrobianos [Internet]. Ginebra: OMS; 2021 [citado 20/12/2024]. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/antimicrobial-resistance
3. Organización Panamericana de la Salud. Resistencia a los antimicrobianos [Internet]. Washington DC: OPS; 2024 [citado 20/12/2024]. Disponible en: https://www.paho.org/es/temas/resistencia-antimicrobianos
4. Organización Mundial de la Salud. Resistencia a los antibióticos [Internet]. Ginebra: OMS; 2020 [citado 20/12/2024]. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/antibiotic-resistance
5. Rodríguez VM, Clara L, Klajn D, et al. Estudio multicéntrico de adherencia a guías de profilaxis quirúrgica y sus determinantes en Argentina. Rev Panam Salud Pública. 2020;44:e52. DOI: 10.26633/RPSP.2020.52.
6. De la Torre Hernández N, Escalona Pupo GI. Comportamiento de pacientes con infecciones del sitio quirúrgico. Holguín, 2018-2021. HolCien [Internet]. 2021 [citado 20/12/2024];2(2). Disponible en: https://revholcien.sld.cu/index.php/holcien/article/view/234/106
7. Duarte Linares Y, Portal Benítez LN, Rodríguez Rojas DA, et al. Caracterización de pacientes con infección del sitio quirúrgico. Acta Méd Centro [Internet]. 2021 [citado 20/12/2024];15(3):366-74. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S2709-79272021000300366
8. Marrero Domínguez AD, Castillo Lamas L, Fernández Jorge J, et al. Infección asociada a la asistencia sanitaria en un servicio de cirugía. Rev Cubana Cir [Internet]. 2022 [citado 20/12/2024];61(4). Disponible en: https://revcirugia.sld.cu/index.php/cir/article/view/1435
9. Del Toro López MD, Arias Díaz J, Balibreac JM, et al. Resumen ejecutivo del Documento de Consenso de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y de la Asociación Española de Cirujanos (AEC) en profilaxis antibiótica en cirugía. Cir Esp. 2021;99(1):11-26. DOI: 10.1016/j.ciresp.2020.03.022.
10. Baker AL, McElrath A, Giancola SE, et al. A Multidisciplinary Approach to Improvements in Perioperative Antibiotic Prophylaxis at a Military Treatment Facility. Mil. 2023;188(7-8):e1854-8. DOI: 10.1093/milmed/usad016.
11. Yalamanchi P, Parent AL, Baetzel AE, et al. Optimization of Antibiotic Prophylaxis Delivery for Pediatric Surgical Procedures. Pediatrics. 2021;148(2):e2020001669. DOI: 10.1542/peds.2020-001669.
12. Organización Mundial de la Salud. Global report on infection prevention and control [Internet]. Ginebra: OMS; 2022 [citado 20/12/2024]. Disponible en: https://www.who.int/publications/i/item/9789240051164
13. Organización Panamericana de la Salud. Tratamiento de las enfermedades infecciosas 2024-2026 [Internet]. Washington, DC: OPS; 2024 [citado 20/12/2024]. Disponible en: https://www.paho.org/es/documentos/tratamiento-enfermedades-infecciosas-2024-2026-novena-edicion
14. National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment [Internet]. London: NICE; 2020 [citado 20/12/2024]. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK542473/
15. Llanqui Encinas EK. Adherencia a la guía de profilaxis antibiótica en cirugía abdominal en Hospital Daniel Alcides Carrión Tacna, septiembre–noviembre 2019 [tesis en Internet]. Tacna: Universidad Nacional Jorge Basadre Grohmann; 2021 [citado 20/12/2024]. Disponible en: https://repositorio.unjbg.edu.pe/bitstreams/50cb7cdb-c844-45b2-a6ed-43e3f83904df/download
16. Schmitt C, Aparecida Lacerda R, Teresa Turrini RN, et al. Improving compliance with surgical antibiotic prophylaxis guidelines: A multicenter evaluation. Am J Infect Control. 2017;45(10):1111-5. DOI: 10.1016/j.ajic.2017.05.004.
17. González López SL, Marcano Sanz L, Trinchet Soler C, et al. Profilaxis antibiótica perioperatoria en Cirugía Pediátrica (Parte I: cirugía abdominal). MediSur [Internet]. 2005 [citado 20/12/2024];3(5):92-8. Disponible en: https://www.redalyc.org/articulo.oa?id=180019795016
18. Soublet Quevedo AA, Sarmiento Baralt CD, Barrientos Brito CR. Uso de antibioticoterapia profiláctica en el Servicio de Cirugía General del Hospital Saturnino Lora. HolCien [Internet]. 2024 [citado 20/12/2024];5(1). Disponible en: https://revholcien.sld.cu/index.php/holcien/article/view/332/190
19. Sierra Alfonso VM. Caracterización de la actividad quirúrgica en el Hospital Aleida Fernández Chardiet. Medimay [Internet]. 2022 [citado 20/12/2024];29(2):206-17. Disponible en: https://revcmhabana.sld.cu/index.php/rcmh/article/view/1562
20. Ministerio de Salud Pública. Formulario Nacional de Medicamentos. La Habana: Ecimed; 2014.
21. World Medical Association. WMA Declaration of Helsinki: ethical principles for medical research involving human participants [Internet]. Ferney-Voltaire: World Medical Association; 2013 [citado 20/12/2024]. Disponible en: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/
22. Fustamante Flores FF, Paiva Del Solar MJ, Umemoto Morimoto D. Profilaxis antibiótica en cirugías abdominales y urológicas en el Hospital Cayetano Heredia en Lima, Perú - 2019 [tesis en Interent]. Lima: Universidad Cayetano Heredia; 2020 [citado 20/12/2024]. Disponible en: https://repositorio.upch.edu.pe/handle/20.500.12866/7845
23. Ortega Peñate JA, Núñez Peláez D, Díaz Alfonso O, et al. Caracterización de los pacientes reingresados por postoperatorio complicado en el servicio de Cirugía General. Hospital Universitario Comandante Faustino Pérez. Matanzas. Rev Méd Electrón [Internet]. 2020 [citado 20/12/2024];42(6). Disponible en: https://revmedicaelectronica.sld.cu/index.php/rme/article/view/3980
24. Organización Panamericana de la Salud. Es fundamental la implementación de Programas de Optimización de Antimicrobianos (PROA) [Internet]. Washington, DC: OPS; 2021 [citado 20/12/2024]. Disponible en: https://www.paho.org/es/noticias/17-11-2021-es-fundamental-implementacion-programas-optimizacion-antimicrobianos-proa
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Anet de la C. Ortega-Travieso, Enma Damara Acosta-Reynaldo, Héctor Julio Piñera-Castro, Mayasil Morales-Pérez, Inés Castro-González, Maricel Navarro-Matos
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All content published in this journal is Open Access, distributed under the terms of the CC BY-NC 4.0 License.
It allows:
- Copy and redistribute published material in any medium or format.
- Adapt the content.
This will be done under the following terms:
- Attribute the authors' credits and indicate whether changes were made, in which case it must be in a reasonable way.
- Non-commercial use.
- Recognize the journal where it is published.
The copyrights of each article are maintained, without restrictions.
Guidelines to authors
