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Perioperative antibiotic practices amongst Otorhinolaryngologists (Ear, Nose & Throat Surgeons) in South Africa
Background: The primary goal of perioperative antibiotics is to reduce the rate of surgical site infections (SSI); however, in certain surgical procedures, the use of perioperative antibiotics has been shown to have no impact on the rate of SSI. Inappropriate use of antimicrobials not only comes at...
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| Language: | English |
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Division of General Surgery
2024
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| Summary: | Background: The primary goal of perioperative antibiotics is to reduce the rate of surgical site infections (SSI); however, in certain surgical procedures, the use of perioperative antibiotics has been shown to have no impact on the rate of SSI. Inappropriate use of antimicrobials not only comes at increased cost and risk of side effects to the patient, but also promotes antibiotic resistance. Antibiotic resistance is arguably one of the greatest current and future threats the health sector faces globally; accounting for approximately 700 000 deaths in 2016, which is projected to rise to 10 million by 2050. In otorhinolaryngology, multiple evidence-based guidelines have been developed to guide decision-making regarding antibiotic prophylaxis in ear, nose and throat (ENT), and head and neck surgery. This study aims to provide insight into the adherence of South African ENT surgeons to available evidence-based international guidelines. Methods: An electronic survey was sent to practising ENT Surgeons in South Africa. Surgeons were asked to indicate their personal antibiotic prescribing practise for general and subspecialty procedures. Results: A total of 92 members of the South African ENT society completed the survey. Respondents indicated that they utilize the following resources to guide their decisions regarding perioperative antibiotic prescribing: anecdotal evidence 27 % (25/92), practices of the surgeon's postgraduate training unit 28% (26/92), published international guidelines 28% (26/92), recommendation of their local hospital's microbiologists 14% (13/92), attending anaesthetists discretion 0 % (0/92). Respondents indicated they take the following factors into consideration to guide decisions regarding perioperative antimicrobial use: 48% (35/92) duration of surgery, 85% (78/92) degree of contamination of the surgical field, 8% (7/92) patient's age, 8% (7/92) degree of blood loss, 22% (20/92) HIV status of patient, 32% (20/92) patient's access to hospital. 35% (32/92) of respondents indicated they audit their own rate of wound complications. For paediatric tonsillectomies, 35% (32/92) routinely prescribe perioperative antibiotics. For insertion of tympanostomy tubes, 50% (46/92) prescribe systemic perioperative antibiotics and 77 % (61/92) use ototopicals. Conclusion: There is significant heterogeneity in the use of perioperative antibiotic prescribing practices and variable adherence to international consensus guidelines amongst ENT surgeons in South Africa. In light of the global increase in antibiotic resistance, this study highlights the need for increased awareness regarding the principles of antibiotic stewardship, pre-existing evidence-based guidelines and the need for a locally-generated South African Otorhinolaryngology consensus guideline that promotes safe and rational use of perioperative antibiotic prophylaxis. |
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