Sefah Israel Abebrese, Chetty Sarentha, Yamoah Peter, Bangalee Varsha
Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana.
PLoS One. 2025 Aug 4;20(8):e0329541. doi: 10.1371/journal.pone.0329541. eCollection 2025.
Inappropriate use of surgical antibiotic prophylaxis (SAP) to prevent surgical site infections (SSIs) is noted to be a major contributor of antimicrobial resistance (AMR) globally, including Ghana. This study sought to assess the impact of antimicrobial stewardship (AMS) interventions on SAP guideline compliance and other surgical outcomes including SSI and length of hospital stay.
This was a nine-month quasi-experimental (before- and after-intervention) study. Four months' medical records of 150 obstetric and gynecological surgery patients were collected both before (baseline) and after the implementation of AMS interventions in a teaching hospital in Ghana. The interventions included education on the hospital SAP guidelines and feedback of the baseline survey results to the surgical team. An adapted data collection sheet was used to collect medical records of the included patients. A descriptive analysis was performed, a Pearson's chi-square test and a two-sample Wilcoxon (Mann-Whitney U) rank-sum test were used to assess the impact of the interventions.
Most (n = 220/300, 73.33%) of the patients were between the ages of 24-44 years, and the commonest surgery was an emergency caesarean section (n = 92/300, 30.67%). After the AMS interventions, there was a significant improvement in guideline compliance due to appropriate antibiotic choice (p = 0.001). duration (p < 0.001), and the volume of consumption of SAP (p < 0.001). There were no significant changes in the timing of administration (p = 0.636), SSI rate (p = 0.054), and the length of hospital stay (p = 0.161).
Our study showed positive impact of the two AMS interventions on SAP guideline compliance based on the choice and duration of prescription, and reduction of the volume of antibiotic utilization, but not on the timing of administration. This did not worsen the SSI rate and patient length of stay. Hospitals in Ghana and beyond are encouraged to optimize SAP use and prevent rising AMR rates by implementing appropriate educational programmes and dissemination of audit findings.
手术预防性使用抗生素（SAP）以预防手术部位感染（SSI）的不当使用被认为是全球包括加纳在内的抗菌药物耐药性（AMR）的主要促成因素。本研究旨在评估抗菌药物管理（AMS）干预措施对SAP指南依从性以及包括SSI和住院时间在内的其他手术结局的影响。
这是一项为期九个月的准实验性（干预前后）研究。在加纳一家教学医院实施AMS干预措施之前（基线）和之后，收集了150例妇产科手术患者的四个月医疗记录。干预措施包括关于医院SAP指南的教育以及向手术团队反馈基线调查结果。使用一份经过改编的数据收集表收集纳入患者的医疗记录。进行了描述性分析，使用Pearson卡方检验和两样本Wilcoxon（Mann-Whitney U）秩和检验来评估干预措施的影响。
大多数（n = 220/300，73.33%）患者年龄在24 - 44岁之间，最常见的手术是急诊剖宫产（n = 92/300，30.67%）。在AMS干预措施实施后，由于抗生素选择得当（p = 0.001）、使用持续时间（p < 0.001）以及SAP的使用量（p < 0.001），指南依从性有显著改善。给药时间（p = 0.636）、SSI发生率（p = 0.054）和住院时间（p = 0.161）没有显著变化。
我们的研究表明，基于处方的选择和持续时间以及抗生素使用量的减少，这两项AMS干预措施对SAP指南依从性有积极影响，但对给药时间没有影响。这并未使SSI发生率和患者住院时间恶化。鼓励加纳及其他地区的医院通过实施适当的教育计划和传播审核结果来优化SAP的使用并防止AMR率上升。
