ABSTRACT
Background:
Surgical site infections (SSIs) represent a significant challenge following general surgical procedures, affecting approximately 1 in 24 patients undergoing inpatient surgery in the United States. Despite advances in antibiotic therapies and antiseptic techniques, SSIs continue to impact surgical outcomes. Effective prophylactic antibiotic administration is critical for reducing SSI rates. This study aims to evaluate the effectiveness of single versus multiple-dose antibiotic prophylaxis in preventing SSIs in clean and clean-contaminated surgical procedures.
Methodology:
This prospective, comparative study was conducted at the Department of General Surgery, Madha Medical College and Research Institute. A total of 80 individuals receiving general surgical interventions with either sterile or slightly contaminated wounds were included. The sample size was calculated to achieve 95% confidence and 80% power. Patients were randomly assigned to receive either a single dose of antibiotic prophylaxis within 4 hours before surgery (Group A) or multiple doses (one the day before the operation and another 4 hours before the operation) (Group B). Postoperative monitoring was performed from days 3 to 8, with wound swab cultures taken for cases exhibiting signs of infection. Statistical analysis was performed using SPSS, with significance set at P < 0.05.
Results:
The study found no significant difference in SSI rates between the single-dose and multiple-dose prophylaxis groups. Both groups showed comparable outcomes regarding wound infections and clinical parameters such as patient temperature and wound discharge. The Chi-square test and independent sample t-test revealed no statistically significant differences in infection rates between the two prophylaxis regimens.
Conclusion:
The findings suggest that a single dose of antibiotic prophylaxis is as effective as multiple doses in preventing SSIs in clean and clean-contaminated surgical procedures. The lack of significant difference in infection rates indicates that single-dose prophylaxis may be a viable alternative to multiple doses, potentially simplifying the prophylaxis protocol and reducing the risk of antibiotic resistance.
KEYWORDS: Antibiotic prophylaxis, infections, laparoscopic surgeries, orthopedic surgeries, surgical site infections
INTRODUCTION
Surgical site infections (SSIs) represent a prevalent concern following a variety of general surgical procedures.[1] In the United States, it is estimated that SSIs affect approximately 1 in 24 patients undergoing inpatient surgery.[2] Despite significant advancements in antibiotic therapies, antiseptic techniques, and early detection and treatment strategies, SSIs continue to pose a substantial challenge to surgical outcomes.[3] This study aims to evaluate the effectiveness of single versus multiple-dose antibiotic prophylaxis in preventing SSIs in both clean and clean-contaminated surgical procedures.
MATERIALS AND METHODS
Study design
This prospective, comparative study was conducted at the Department of General Surgery, Madha Medical College and Research Institute. The study included a total of 80 patients who met the specified inclusion and exclusion criteria.
Data sources and variables
The primary data for this study were collected through a predesigned case record proforma, capturing patient details, clinical findings, and investigation reports. Key study variables included clinical parameters such as patient temperature, heart rate, and any exudate from the wound site. Furthermore, wound swab cultures and standard blood tests were evaluated. This research differentiated between two groups: Group A, comprising individuals administered a single dose of prophylactic antibiotics within 4 hours before the operation, and Group B, consisting of patients who received multiple doses, including one the day before the procedure and again 4 hours beforehand the operation. Post-operative wound sites were monitored for signs of infection from days 3 to 8, with cultures performed on wounds exhibiting discharge or other infection indicators.
RESULTS
The study found no significant difference between single-dose and multiple-dose antibiotic prophylaxis in preventing surgical site infections (SSIs). Both regimens demonstrated comparable outcomes regarding postoperative fever, tachycardia, wound discharge, and leucocytosis, indicating similar efficacy. Thus, a single dose of antibiotics appears sufficient and could simplify prophylactic protocols without compromising patient safety [Tables 1-5].
Table 1.
Shows the Demographic characteristics of study participants
| Characteristic | Group A (Single Dose) | Group B (Multiple Doses) | Total | P |
|---|---|---|---|---|
| Number of Patients | 40 | 40 | 80 | - |
| Age (Mean±SD) | 45.2±12.5 | 46.1±13.2 | 45.7±12.8 | 0.7692 |
| Gender (Male/Female) | 24/16 | 26/14 | 50/30 | 0.3006 |
Table 5.
Summarises Postoperative leucocytosis
| Leukocytosis | Group A (Single Dose) | Group B (Multiple Doses) | Total | P |
|---|---|---|---|---|
| Leukocytosis (>11,000/mL) | 10 (25.0%) | 8 (20.0%) | 18 (22.5%) | 0.4864 |
| Normal Leucocyte Count | 30 (75.0%) | 32 (80.0%) | 62 (77.5%) | 0.4864 |
Table 2.
Presents the Preoperative clinical parameters
| Parameter | Group A (Single Dose) | Group B (Multiple Doses) | Total | P |
|---|---|---|---|---|
| Temperature (°C) | 37.2±0.5 | 37.1±0.4 | 37.1±0.5 | 0.6415 |
| Pulse Rate (bpm) | 78.3±10.2 | 77.8±9.8 | 78.1±10.0 | 0.7231 |
Table 3.
Displays Postoperative Fever and Tachycardia
| Parameter | Group A (Single Dose) | Group B (Multiple Doses) | Total | P |
|---|---|---|---|---|
| Postoperative Fever (%) | 8 (20.0%) | 5 (12.5%) | 13 (16.3%) | 0.281 |
| No Postoperative Fever (%) | 32 (80.0%) | 35 (87.5%) | 67 (83.7%) | 0.281 |
| Postoperative Tachycardia (%) | 7 (17.5%) | 8 (20.0%) | 15 (18.8%) | 0.7193 |
| No Postoperative Tachycardia (%) | 33 (82.5%) | 32 (80.0%) | 65 (81.2%) | 0.7193 |
Table 4.
Reports Wound discharge characteristics
| Wound Discharge | Group A (Single Dose) | Group B (Multiple Doses) | Total | P |
|---|---|---|---|---|
| Nil | 30 (75.0%) | 31 (77.5%) | 61 (76.3%) | 0.896 |
| Purulent | 4 (10.0%) | 3 (7.5%) | 7 (8.8%) | 0.5967 |
| Seropurulent | 6 (15.0%) | 6 (15.0%) | 12 (15.0%) | 1 |
DISCUSSION
This study compared the efficacy of single-dose versus multiple-dose antibiotic prophylaxis in preventing surgical site infections in clean and clean-contaminated general surgeries.[4] No significant differences were observed between the two groups in terms of postoperative fever, tachycardia, wound discharge, or leucocytosis.[5] The low and comparable rates of purulent discharge and infection markers in both groups support the clinical equivalence of the two regimens.[6] These findings align with prior studies that favor single-dose prophylaxis for its simplicity and comparable efficacy.[7] Prolonged antibiotic use offers no additional benefit and may increase the risk of antimicrobial resistance and adverse effects.[8] A single-dose regimen is easier to implement, promotes better compliance, and supports antimicrobial stewardship.[9] The study also reinforces that reduced antibiotic exposure may lower the incidence of drug-related complications.[10] Limitations include a modest sample size and short follow-up, which may not capture delayed infections. Nevertheless, the results advocate for single-dose prophylaxis as an effective, safe, and resource-efficient strategy in general surgical settings.
CONCLUSIONS
In summary, this study demonstrates that a single dose of antibiotic prophylaxis is as effective as multiple doses in preventing postoperative infections and complications. The findings reveal no significant differences in fever, tachycardia, wound discharge, leukocytosis, or overall complications between the two regimens.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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