Pharmacoeconomic Analysis of Peri-Surgical Antibiotics and Surgical Site Infections in Livingstone General Hospital, Zambia
Keywords:
medicineAbstract
Background: There is significant evidence to support the use of single dose surgical antibiotic prophylaxis in
prevention of surgical site infections (SSI). Multiple peri-operative antibiotic doses have been observed in
African hospitals by students on elective placements with unknown clinical and financial consequences.
Objective: To investigate the use of prophylactic surgical antibiotics in Livingstone General Hospital, Zambia,
in the areas of suitability, combinations, duration, cost and incidence of SSI. Furthermore, to compare these
findings with evidence from the literature and current best-practice at St James’s Hospital (SJH) in order to
determine any possible benefits from the pharmacoeconomic optimisation of current regimes. Methods: A
retrospective analysis of all surgical patient files from January to July, 2006. Results: The data gathered
demonstrates a lack of prophylactic protocols and resultant ad-hoc antibiotic administration that sometimes
lacked pharmacological rationale. In spite of evidence in the literature to the contrary, dosing was continued
in all cases for several days. The absence of a prophylactic protocol results in increased expenditure on
antibiotics without proven patient benefit and may contribute to surgical site infections with resistant
organisms. The occurrence of surgical site infections was 23% and is associated with a significant cost of
€133.84 per infection. In the context of limited health budgets in developing countries, this result is likely highly
significant. Conclusions: The implementation of single dose prophylactic protocols can be expected to result
in significant financial savings and may reduce the cost of treating surgical site infections. Investigation into
financially feasible modifiable factors contributing to SSI would lead to significant savings and improved patient
outcome.
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