The impact of antimicrobial stewardship interventions on surgical antibiotic prophylaxis guidelines compliance in a teaching hospital in Ghana

Abstract

Background 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. Method 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. Results 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). Conclusion 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.