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Benefit of a single preoperative dose of antibiotics in a sub-saharan district hospital: minimal input, massive impact

Saxer, Franziska and Widmer, Andreas and Fehr, Jan and Soka, Isaac and Kibatala, Pascience and Urassa, Honorathy and Frei, Reno and Smith, Thomas and Hatz, Christoph. (2009) Benefit of a single preoperative dose of antibiotics in a sub-saharan district hospital: minimal input, massive impact. Annals of surgery : a monthly review of surgical science and practice, Vol. 249, H. 2. pp. 322-326.

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Official URL: http://edoc.unibas.ch/dok/A5843154

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Abstract

OBJECTIVE: To evaluate the impact of a single-shot preoperative antimicrobial prophylaxis (AMP) to reduce the rate of Surgical Site Infections (SSIs) in a rural sub-Saharan hospital. SUMMARY BACKGROUND DATA: We analyzed the incidence of SSIs in a rural Tanzanian hospital with very limited resources and found that AMP was administered after incision in 88% without covering the expected pathogens. Inadequacy and mistiming of AMP proved to be major risk factors for SSI in this study. Subsequently, 21.6% of patients developed an SSI after clean or clean-contaminated surgery, with 60% of detected pathogens being resistant to the administered antibiotics. In developed countries, preoperative single shot AMP is widely used and effective in the prevention of SSI. METHODS: Implementation and monitoring of guidelines for routine and adequate single shot AMP within 2 hours prior to incision in every clean and clean-contaminated intervention. RESULTS: In the preintervention group, 527 patients qualified for routine AMP that was administered in 88% of patients after incision and did not cover the expected pathogens to a large extent.114 patients (21.6%) developed an SSI, with 60% of detected pathogens being resistant to the administered antibiotics. After implementation of the guidelines, the incidence of SSIs significantly decreased from 21.6% to 4% (11/276). CONCLUSIONS: The implementation of a single shot AMP dramatically decreased the rate of SSI in a hospital with very limited resources. Such guidelines, developed by industrialized countries, are even more effective in non-industrialized countries
Faculties and Departments:03 Faculty of Medicine > Bereich Querschnittsfächer (Klinik) > Labormedizin > Klinische Mikrobiologie (Frei)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Querschnittsfächer (Klinik) > Labormedizin > Klinische Mikrobiologie (Frei)
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Infektiologie > Infektiologie (Battegay M)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Infektiologie > Infektiologie (Battegay M)
03 Faculty of Medicine > Departement Public Health > Sozial- und Präventivmedizin > Medical Services (Neumayr)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Medicine > Medical Services (Neumayr)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Infectious Disease Modelling > Infectious Disease Modelling (Smith)
UniBasel Contributors:Smith, Thomas A. and Widmer, Andreas F.-X. and Frei, Reno and Hatz, Christoph
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Lippincott Williams & Wilkins
ISSN:0003-4932
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:01 Mar 2013 11:12
Deposited On:14 Sep 2012 06:46

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