{"doi":"10.1093/bjs/znad438","title":"An observational cohort study on the effects of extended postoperative antibiotic prophylaxis on surgical-site infections in low- and middle-income countries","abstract":"BACKGROUND: Worldwide, approximately one in six inpatient antibiotic prescriptions are for surgical-infection prophylaxis, including postoperative prophylaxis. The WHO recommends against prolonged postoperative antibiotics to prevent surgical-site infection. However, in many low- and middle-income countries, postoperative antibiotic prophylaxis is common due to perceptions that it protects against surgical-site infection and data informing recommendations against antibiotic administration are largely derived from high-income countries. The aim of this study was to describe postoperative antibiotic-prescribing patterns and related surgical-site infection rates in hospitals in low- and middle-income countries. METHODS: Patients from 19 hospitals in Ethiopia, Madagascar, India, and Bolivia with wound class I and II operations were included. Data on antibiotic administration, indication, surgical-site infection, length of hospital stay, and adherence to perioperative infection-prevention standards were collected by trained personnel. The association between postoperative antibiotic prophylaxis for greater than or equal to 24 h and surgical-site infection was analysed via modified robust Poisson regression, controlling for patient and procedural factors and degree of adherence to perioperative infection-prevention practices. RESULTS: Of 8714 patients, 92.9% received antibiotics for prophylaxis after surgery and 27.7% received antibiotics for greater than or equal to 24 h. Patients receiving postoperative prophylaxis for greater than or equal to 24 h did not have lower surgical-site infection rates (Relative risk 1.09 (95% c.i. 0.89 to 1.33); P = 0.399), but the length of hospital stay was 1.4 days longer (P < 0.001). CONCLUSION: Prolonged postoperative antibiotics did not reduce surgical-site infection, but pervasive use was associated with a longer length of hospital stay, in resource-limited healthcare systems. With the growing threat of antimicrobial resistance, surgical initiatives to implement antimicrobial stewardship programmes in low- and middle-income countries are critical.","journal":"British journal of surgery","year":2024,"id":431302,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9575,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1116147,"name":"Maia R. Nofal","orcid":"0000-0003-2532-4514","position":1,"is_corresponding":false},{"id":1235616,"name":"Alex Zhuang","orcid":null,"position":2,"is_corresponding":false},{"id":326516,"name":"Natnael Atnafu Gebeyehu","orcid":"0000-0002-3589-891X","position":3,"is_corresponding":false},{"id":326512,"name":"Nichole Starr","orcid":"0000-0003-0714-5512","position":4,"is_corresponding":false},{"id":1235617,"name":"Sara Taye Haile","orcid":null,"position":5,"is_corresponding":false},{"id":1235618,"name":"Habtamu Woldeamanuel","orcid":null,"position":6,"is_corresponding":false},{"id":978495,"name":"Assefa Tesfaye","orcid":null,"position":7,"is_corresponding":false},{"id":1116657,"name":"Senait Bitew Alemu","orcid":null,"position":8,"is_corresponding":false},{"id":326518,"name":"Abebe Bekele","orcid":"0000-0003-0018-9096","position":9,"is_corresponding":false},{"id":520910,"name":"Tihitena Negussie Mammo","orcid":"0000-0003-3730-4246","position":10,"is_corresponding":false},{"id":326519,"name":"Thomas G. Weiser","orcid":"0000-0002-3118-3888","position":11,"is_corresponding":false},{"id":1235130,"name":"Abdi Amin Abdukadir","orcid":"0000-0002-0539-4059","position":12,"is_corresponding":false},{"id":1235619,"name":"Belay Mellese Abebe","orcid":null,"position":13,"is_corresponding":false},{"id":1235620,"name":"Ananya K. 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