{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T03:00:14Z","timestamp":1777950014689,"version":"3.51.4"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100023674","name":"Deanship of Scientific Research, King Khalid University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100023674","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgical antibiotic prophylaxis (SAP) is an essential part of perioperative care, yet adherence to recommended practices varies across surgical categories. Differences in antibiotic choice and duration between clean and clean-contaminated procedures highlight the need to understand local prescribing patterns. This study aimed to describe SAP practices in a tertiary care hospital and assess adherence to institutional SAP guidelines in clean and clean-contaminated surgeries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A prospective observational cross-sectional study was conducted over 6 months in a tertiary care hospital. Adult patients undergoing elective clean or clean-contaminated surgeries were included. Information on perioperative antibiotic use was collected from medical records, and adherence to institutional prophylaxis guidelines was assessed. Data were analyzed using descriptive statistics, Chi-square or Fisher's exact tests,\n                      <jats:italic>t<\/jats:italic>\n                      -tests, relative risks, odds ratios, and multivariate logistic regression. A two-tailed\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 170 patients were assessed, including 143 clean and 27 clean-contaminated surgical cases. Significant differences were observed in antibiotic selection between the two categories; cefuroxime was used more frequently in clean surgeries (50.3%) than in clean-contaminated procedures (25.9%), with a relative risk of 1.94 (95% CI 1.00\u20133.78;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.037). Clean surgeries were associated with higher adherence to guideline-recommended prophylaxis, particularly for appropriate antibiotic choice (83.2 vs. 63.0%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.032) and appropriate duration (90.2 vs. 66.7%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003). Overall appropriateness, measured using the Antibiotic Prophylaxis Appropriateness Index (APAI), was higher in clean surgeries (89.4%) compared with clean-contaminated procedures (76.3%;\n                      <jats:italic>z<\/jats:italic>\n                      = 2.98;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003). In multivariate analysis, clean-contaminated surgery (adjusted OR 3.89; 95% CI 1.37\u201311.05;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.009) and prolonged prophylaxis duration (adjusted OR 4.61; 95% CI 1.74\u201312.18;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003) were independently associated with non-adherence. Surgical site infections were infrequent, with two cases (1.4%) reported in clean surgeries and none following clean-contaminated procedures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Antibiotic prophylaxis practices varied between clean and clean-contaminated surgeries, with higher adherence observed in clean procedures, particularly in antibiotic selection and duration. Prolonged prophylaxis was more common in clean-contaminated surgeries and was associated with non-adherence. Given the observational design, causal inferences cannot be established. These findings highlight potential targets for improving guideline-based prophylaxis through antimicrobial stewardship strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1759017","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:33:20Z","timestamp":1777872800000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic usage in surgical prophylaxis: surveillance of clean and clean-contaminated surgeries in a tertiary care hospital"],"prefix":"10.3389","volume":"14","author":[{"given":"Geetha","family":"Kandasamy","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vijayakumar","family":"Arumugam","sequence":"additional","affiliation":[{"name":"Head Pharmacy Services, Kovai Medical Center and Hospital (KMCH)","place":["Coimbatore, India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid","family":"Orayj","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona","family":"Almanasef","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rayah","family":"Asiri","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asma M.","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Shaqra University","place":["Dawadimi, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amjad","family":"Hmlan","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Khalid University","place":["Abha, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanan","family":"Alshareef","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk","place":["Tabuk, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavitha","family":"Karunakaran","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, KMCH College of Pharmacy","place":["Coimbatore, India"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"B1","first-page":"925","article-title":"Antimicrobial prophylaxis in surgery. Committee on antimicrobial agents, Canadian infectious disease society","volume":"151","author":"Waddell","year":"1994","journal-title":"CMAJ"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S85","DOI":"10.1086\/518136","article-title":"Health care-associated infections: major issues in the early years of the 21st century","volume":"45","author":"Wenzel","year":"2007","journal-title":"Clin Infect Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"196","DOI":"10.3201\/eid0902.020232","article-title":"Health and economic impact of surgical site infections diagnosed after hospital discharge","volume":"9","author":"Perencevich","year":"2003","journal-title":"Emerg Infect Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"582","DOI":"10.2146\/ajhp120568","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery","volume":"70","author":"Bratzler","year":"2013","journal-title":"Best Pract Hosp Heal Pharm."},{"key":"B5","year":"2014","journal-title":"Standard Treatment Guidelines For General Hospital: Good Prescribing & Dispensing Practices for Better Health Outcomes"},{"key":"B6","doi-asserted-by":"publisher","first-page":"534","DOI":"10.4066\/AMJ.2012.1312","article-title":"Surgeons' adherence to guidelines for surgical antimicrobial prophylaxis-A review","volume":"5","author":"Ng","year":"2012","journal-title":"Australas Med J."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4172\/1920-4159.1000220","article-title":"Utilization assessment of surgical antibiotic prophylaxis at ayder referral hospital, Northern Ethiopia","volume":"8","author":"Mohamoud","year":"2016","journal-title":"J Appl Pharm."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e187","DOI":"10.1016\/j.ijid.2011.11.010","article-title":"Impact of a national hospital evaluation program using clinical performance indicators on the use of surgical antibiotic prophylaxis in Korea","volume":"16","author":"Kim","year":"2012","journal-title":"Int J Infect Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"225","DOI":"10.18773\/austprescr.2017.073","article-title":"Surgical antimicrobial prophylaxis","volume":"40","author":"Ierano","year":"2017","journal-title":"Aust Prescr."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e136","DOI":"10.3346\/jkms.2019.34.e136","article-title":"Appropriate use of surgical antibiotic prophylaxis","volume":"34","author":"Kwak","year":"2019","journal-title":"J Kor Med Sci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.amjsurg.2005.01.015","article-title":"Surgical infection prevention guideline writers workgroup antimicrobial prophylaxis for surgery: an advisory statement from the national surgical infection prevention project","volume":"189","author":"Bratzler","year":"2005","journal-title":"Am J Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1001\/archsurg.1993.01420130087014","article-title":"Antimicrobial prophylaxis for surgical wounds: guidelines for clinical care","volume":"128","author":"Page","year":"1993","journal-title":"Arch Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1086\/646887","article-title":"Quality standard for antimicrobial prophylaxis in surgical procedures","volume":"15","author":"Dellinger","year":"1994","journal-title":"Infect Control Hosp Epidemiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.1093\/ajhp\/56.18.1839","volume":"56","year":"1999","journal-title":"Am J Health Syst Pharm"},{"key":"B15","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1086\/501620","article-title":"Hospital infection control practices advisory committee guideline for prevention of surgical site infection, 1999","volume":"20","author":"Mangram","year":"1999","journal-title":"Infect Control Hosp Epidemiol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1089\/sur.2013.9999","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery","volume":"14","author":"Bratzler","year":"2013","journal-title":"Surg Infect"},{"key":"B17","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1016\/j.surg.2004.06.022","article-title":"Perioperative antibiotic prophylaxis in the gastric bypass patient: do we achieve therapeutic levels?","volume":"136","author":"Edmiston","year":"2004","journal-title":"Surgery."},{"key":"B18","article-title":"(Cefotaxime Sodium) for Injection Package Insert","year":"2009"},{"key":"B19","doi-asserted-by":"publisher","first-page":"S173","DOI":"10.1111\/j.1600-6143.2009.02909.x","article-title":"Candida in solid organ transplant recipients","volume":"9","author":"Pappas","year":"2009","journal-title":"Am J Transplant."},{"key":"B20","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for disease control and prevention guideline for the prevention of surgical site infection","volume":"152","author":"Berr\u00edos-Torres","year":"2017","journal-title":"JAMA Surg."},{"key":"B21","year":"2018","journal-title":"Global Guidelines for the Prevention of Surgical Site Infection"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3627","DOI":"10.2147\/IDR.S281097","article-title":"Surgical site infections and prophylaxis antibiotic use in the surgical ward of public hospital in Western Ethiopia: a hospital-based retrospective cross-sectional study","volume":"13","author":"Kefale","year":"2020","journal-title":"Infect Drug Resist."},{"key":"B23","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/S0140-6736(10)61458-4","article-title":"Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis","volume":"377","author":"Allegranzi","year":"2011","journal-title":"Lancet"},{"key":"B24","unstructured":"Geneva\n          WHO\n          Global Guidelines for the Prevention of Surgical Site Infection, 2nd Edn\n          \n          2018"},{"key":"B25","first-page":"OC06","article-title":"Surgical site infections in elective and emergency abdominal surgeries: a prospective study from Jodhpur, India","volume":"17","author":"Jatoliya","year":"2023","journal-title":"J Clin Diagn Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1016\/j.mpsur.2012.10.001","article-title":"Antibiotic prophylaxis","volume":"30","author":"Hall","year":"2012","journal-title":"Surgery"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e12251","DOI":"10.5812\/jjm.12251","article-title":"Antibiotics use patterns for surgical prophylaxis site infection in different surgical wards of a teaching hospital in Ahvaz, Iran","volume":"7","author":"Alavi","year":"2014","journal-title":"Jundishapur J Microbiol."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1086\/502396","article-title":"Adherence with guidelines on antibiotic prophylaxis in total hip replacement surgery: results of a retrospective study of 416 patients in a teaching hospital","author":"Bedouch","year":"2004","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1177\/0018578718792804","article-title":"A retrospective surveillance of the antibiotics prophylactic use of surgical procedures in private hospitals in Indonesia","volume":"54","author":"Herawati","year":"2019","journal-title":"Hosp Pharm."},{"key":"B30","doi-asserted-by":"publisher","first-page":"686","DOI":"10.4065\/mcp.2011.0012","article-title":"Antimicrobial prophylaxis in adults","volume":"86","author":"Enzler","year":"2011","journal-title":"Mayo Clin Proc."},{"key":"B31","doi-asserted-by":"publisher","first-page":"e51","DOI":"10.1093\/cid\/ciw118","article-title":"Implementing an antibiotic stewardship program: guidelines by the infectious diseases society of America and the society for healthcare epidemiology of America","volume":"62","author":"Barlam","year":"2016","journal-title":"Clin Infect Dis."},{"key":"B32","doi-asserted-by":"publisher","first-page":"168","DOI":"10.3390\/antibiotics9040168","article-title":"Impact of antimicrobial stewardship interventions on appropriateness of surgical antibiotic prophylaxis: how to improve","volume":"9","author":"Tiri","year":"2020","journal-title":"Antibiotics"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e0329541","DOI":"10.1371\/journal.pone.0329541","article-title":"The impact of antimicrobial stewardship interventions on surgical antibiotic prophylaxis guidelines adherence in a teaching hospital in Ghana","volume":"20","author":"Sefah","year":"2025","journal-title":"PLoS One"},{"key":"B34","first-page":"62","article-title":"prospective observational study on antibiotic usage for surgical prophylaxis in a tertiary care hospital","volume":"59","author":"Jiji","year":"2019","journal-title":"Int J Pharm Sci Rev Res."},{"key":"B35","doi-asserted-by":"publisher","year":"","DOI":"10.1371\/journal.pone.0203523"},{"key":"B36","first-page":"2","article-title":"Surgical antibiotic prophylaxis in a tertiary care teaching hospital in India","author":"Rehan","year":"2010","journal-title":"Int. J. Infect. Cont."},{"key":"B37","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.jtumed.2022.08.012","article-title":"Appropriateness of choice and duration of surgical antibiotic prophylaxis and the incidence of surgical site infections: a prospective study","volume":"18","author":"Thabit","year":"2023","journal-title":"J Taibah Univ Med Sci."},{"key":"B38","doi-asserted-by":"publisher","first-page":"14689","DOI":"10.1038\/s41598-023-41834-7","article-title":"Surgical site infection and antimicrobial prophylaxis prescribing profile, and its determinants among hospitalized patients in Northeast Ethiopia: a hospital based cross-sectional study","volume":"13","author":"Habteweld","year":"2023","journal-title":"Sci Rep."},{"key":"B39","first-page":"841","article-title":"The study of antibiotic prophylaxis in clean and clean-contaminated surgical wounds","volume":"17","author":"Dilip","year":"2025","journal-title":"Int J Curr Pharm Rev Res."},{"key":"B40","doi-asserted-by":"publisher","first-page":"e276","DOI":"10.1016\/S1473-3099(16)30398-X","article-title":"New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective","volume":"16","author":"Allegranzi","year":"2016","journal-title":"Lancet Infect Dis."},{"key":"B41","first-page":"e19","article-title":"Timing of preoperative antibiotic prophylaxis and the risk of surgical site infection: a systematic review and meta-analysis","volume":"104","author":"De Jonge","year":"2017","journal-title":"Br J Surg."},{"key":"B42","doi-asserted-by":"publisher","first-page":"663","DOI":"10.26719\/2011.17.8.663","article-title":"Evaluation of prophylactic antibiotic administration at the surgical ward of a major referral hospital, Islamic Republic of Iran","volume":"17","author":"Vessal","year":"2011","journal-title":"East Mediterr Heal J."},{"key":"B43","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s11096-012-9719-y","article-title":"An audit of prophylactic surgical antibiotic use in a Sudanese Teaching Hospital","volume":"35","author":"Elbur","year":"2013","journal-title":"Int J Clin Pharm."},{"key":"B44","doi-asserted-by":"publisher","first-page":"842593","DOI":"10.1155\/2013\/842593","article-title":"Adherence of surgeons to antimicrobial prophylaxis guidelines in a tertiary general hospital in a rapidly developing country","volume":"2013","author":"Abdel-Aziz","year":"2013","journal-title":"Adv Pharmacol Sci."},{"key":"B45","first-page":"411","article-title":"Application of guidelines on preoperative antibiotic prophylaxis in Leon, Nicaragua","volume":"64","author":"Van Disseldorp","year":"2006","journal-title":"Neth J Med."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1759017\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:33:22Z","timestamp":1777872802000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1759017\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2026.1759017"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1759017","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]},"article-number":"1759017"}}