In only 20.7% of surgeries, prescribers followed surgical antibiotic prophylaxis (SAP) protocols for procedures performed at a university hospital in Sao Paulo, Brazil, finds a study published yesterday in the American Journal of Infection Control.

University of Sao Paulo researchers assessed prescriber adherence to SAP protocols and contributing factors among surgeries performed by cardiologists, urologists, neurologists, and gastrointestinal specialists. They compared SAP prescriptions to hospital protocols on surgical indication and antibiotic choice, dosage, and duration.

"Surgical antibiotic prophylaxis (SAP) is an important preventive measure, aiming to minimize surgical site infections," the study authors wrote. "However, despite evidence-based guidelines, adherence to SAP protocols remains suboptimal in clinical practice."

Lower adherence for antibiotic choice, duration

Prescribers adhered to SAP protocols for only 20.7% of 1,864 surgeries. Lower adherence rates were observed for antibiotic choice and duration of prophylaxis, particularly for neurologic and urologic procedures. The researchers also said that prescribers used broad-spectrum antibiotics more than necessary.

Despite the relatively high adherence to antibiotic dosage, challenges persist in antibiotic choice and duration adjustment.

Risk factors for nonadherence were high preoperative blood glucose levels, prolonged hospitalization, and long surgeries. Surgical teams had significant influence over protocol adherence.

"Despite the relatively high adherence to antibiotic dosage, challenges persist in antibiotic choice and duration adjustment," the researchers concluded. "Poor glycemic control, prolonged surgery and surgical teams were variables associated with inappropriate practice."

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