Pharmacoeconomic Analysis of Peri-Surgical Antibiotics and Surgical Site Infections in Livingstone General Hospital, Zambia

Authors

  • Martin Arrigan
  • Brigid Halley
  • Peter Hughes
  • Leanne McMenamin
  • Katie O’Sullivan

Keywords:

medicine

Abstract

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.

References

1. Livingstone General Hospital, Livingstone Zambia. Accounting
Department Figures 2006.
2. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ.
The impact of surgical-site infections in the 1990s: attributable
mortality, excess length of hospitalization, and extra costs. Infect
Control Hosp Epidemiol 1999 20:725—730.
3. Eriksen HM, Chugulu S, Kondo S, Lingaas E. Surgical-site
infections at Kilimanjaro Christian Medical Center. Journal of
Hospital Infection 2003 55:14-20
4. Leaper DJ, van Goor H, Reilly J, Petrosillo N, Geiss HK,
Torres AJ et al. Surgical site infection – a European perspective
of incidence and economic burden. International Wound Journal
2004 4:247 – 251
5. St James’s Hospital (Irl). St James’s Hospital Prescriber’s
Guide 2006.
6. Mousseau Marie-Catherine, deputy editor. Monthly Index of
Medical Specialties. Medical Publications (Ireland) Ltd. February
1995
7. Archibald LK, Reller LB. Clinical Microbiology in Developing
Countries. Emerging Infeciton Diseases. 2001 2:302-305
8. Harbarth S, Samore MH, Lichtenberg D, Carmeli Y. Prolonged
Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect
on Surgical Site Infections and Antimicrobial Resistance.
Circulation 2000;101;2916-2921.
9. Scher KS. Studies on the duration of antibiotic administration
for surgical prophylaxis. Am Surg 1997 Jan; 63(1):59-62.
10. Hanssen AD, Osmon DR. The Use of Prophylactic
Antimicrobial Agents During and After Hip Arthroplasty. Clinical
Orthopaedics & Related Research 1999 Dec 369:124-138.
11. Fukatsu K, Saito H, Matsuda T, Ikeda S, Furukawa S, Muto
T et al. Influences of type and duration of antimicrobial
prophylaxis on an outbreak of methicillin resistant
staphylococcus aureus and on the incidence of wound infection.
Arch Surg 1997;132:1320-1325.
12. Berard F, Gandon J. Postoperative wound infections: the
influence of ultraviolet irradiation of the operating room and of
various other factors. Ann Surg 1964; 160 (Suppl 1): 1-192.
13. Cruse PJ, Foord R. The epidemiology of wound infection. A
10-year prospective study of 62,939 wounds. Surg Clin North Am
1980; 60(1): 27-40.
14. Cruse PJE. Classification of operations and audit of infection.
In: Taylor EW, editor. Infection in Surgical Practice. Oxford:
Oxford University Press, 1992; 1-7.
15. Eriksen NH, Espersen F, Rosdahl VT, Jensen K. Carriage of
Staphylococcus aureus among 104 healthy persons during a 19-
month period. Epidemiol Infect 1995; 115(1): 51-60.
16. Whyte W, Hambraeus A, Laurell G, Hoborn J. The relative
importance of routes and sources of wound contamination during
general surgery. I. Non-airborne. J Hosp Infect 1991; 18(2): 93-
107.

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Published

2007-01-01

How to Cite

Arrigan, M. ., Halley, B. ., Hughes, P. ., McMenamin, L. ., & O’Sullivan, K. . (2007). Pharmacoeconomic Analysis of Peri-Surgical Antibiotics and Surgical Site Infections in Livingstone General Hospital, Zambia. Trinity Student Medical Journal , 8(1). Retrieved from https://ojs.tchpc.tcd.ie/index.php/tsmj/article/view/1835

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