Co esponding au ho : Dhan in Chi agbhai Su ha
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
E alua ion and op imiza ion o an ibio ic selec ion o su gical p ophylaxis in
Ahmedabad egion
Dhan in Chi agbhai Su ha *, Ru ika Na anbhai Pa el and Jay Na end akuma Joshi
Pha m D In e n a SAL Hospi al, SAL Ins i u e o Pha macy, Ahmedabad, Guja a , India.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 23(03), 361-376
Publica ion his o y: Recei ed on 05 Augus 2025; e ised on 14 Sep embe 2025; accep ed on 18 Sep embe 2025
A icle DOI: h ps://doi.o g/10.30574/wjbphs.2025.23.3.0848
Abs ac
Objec i es: To assess he an ibio ic p esc ibing ends o su gical p ophylaxis ac oss selec ed heal hca e cen e s in
Ahmedabad and o e alua e hei alignmen wi h s anda d guidelines.
Me hods: This e ospec i e, mul i-cen ic obse a ional s udy was conduc ed o e 6 mon hs ac oss e ia y ca e
hospi als in Ahmedabad. Pa ien eco ds om su gical depa men s we e sc eened o analyses he p ophylac ic
an ibio ic choice, dosage o ms, equency, pos -ope a i e p esc ibing pa e ns, and associa ed pa ame e s. Su ge ies
we e classi ied based on wound ype (clean, clean-con amina ed, con amina ed, di y), and da a was compiled on
demog aphics, cul u e sensi i i y es s, and an ibio ic cos .
Resul s: O he included cases, he majo i y unde wen p ocedu es ca ego ized as clean o clean-con amina ed.
Ce iaxone and Amikacin we e he mos equen ly p esc ibed p ophylac ic an ibio ics, o en in combina ion. In ce ain
cases, non- ecommended agen s such as hi d-gene a ion cephalospo ins we e used indisc imina ely. Cul u e
sensi i i y es ing e ealed p edominan o ganisms including E. coli and S aphylococcus au eus. Despi e a ailable
guidance (ICMR, CDC), no able de ia ions we e obse ed in dosage equency, iming, and an ibio ic co e age, leading
o inc eased cos s and subop imal ou comes.
Conclusion: The indings unde sco e a disconnec be ween p esc ibed su gical p ophylac ic an ibio ics and
ecommended e idence-based guidelines. The e is a need o g ea e awa eness, pe iodic audi s, and s ic e adhe ence
o an imic obial p ophylaxis p o ocols o mi iga e esis ance and imp o e pa ien sa e y. Implemen a ion o
s ewa dship p og ams and educa ion ac oss su gical depa men s could signi ican ly enhance a ional an ibio ic use.
Keywo ds: Su gical Si e In ec ion; An ibio ic P ophylaxis; D ug U iliza ion Re iew; Guideline Adhe ence; Mic obial
Sensi i i y Tes s
1. In oduc ion
Su gical si e in ec ions (SSIs) a e de ined as in ec ions ha occu a o nea he su gical incision si e wi hin 30 days o
su ge y o wi hin one yea i implan s a e in ol ed.1 They a e classi ied in o h ee ca ego ies: supe icial incisional
(in ol ing skin and subcu aneous issue), deep incisional (a ec ing deepe so issues such as ascia and muscle), and
o gan/space in ec ions (in ol ing any pa o he body o he han he incision ha was manipula ed du ing su ge y).
SSIs a e among he mos common heal hca e-associa ed in ec ions, signi ican ly con ibu ing o pa ien mo bidi y,
inc eased heal hca e cos s, and p olonged hospi al s ays.1 The pa hogenesis in ol es mic obial con amina ion du ing
su ge y, wi h isk ac o s including pa ien como bidi ies, su gical du a ion, and inadequa e asep ic echniques.
Common pa hogens include S aphylococcus au eus (including MRSA) and g am-nega i e bac e ia.1 P e en i e
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 23(03), 361-376
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measu es, such as p ope hand hygiene, s e iliza ion o su gical ins umen s, and imely adminis a ion o p ophylac ic
an ibio ics, a e c i ical o educing SSI incidence.2
Su gical si e in ec ions (SSIs) emain a global heal h conce n, disp opo iona ely a ec ing low- and middle-income
coun ies, whe e in ec ion a es can be as high as 20% due o inadequa e esou ces and s e iliza ion p ac ices.3 E en
in high-income na ions, SSIs con ibu e signi ican ly o heal hca e-associa ed in ec ions. The global incidence a ies
widely, in luenced by ac o s such as heal hca e in as uc u e, egional in ec ion con ol p ac ices, and he p e alence
o an imic obial esis ance.3 E o s like he WHO’s Clean Ca e is Sa e Ca e ini ia i e ha e ocused on educing SSIs
h ough educa ion and e idence-based p ac ices.4
In India, su gical si e in ec ions (SSIs) emain a signi ican challenge, wi h epo ed a es anging om 6% o 38%,
pa icula ly in esou ce-limi ed heal hca e se ings.5 Con ibu ing ac o s include limi ed adhe ence o in ec ion con ol
measu es, o e bu dened heal hca e sys ems, and widesp ead an imic obial esis ance.6 SSIs a e among he mos
common heal hca e-associa ed in ec ions in he coun y, disp opo iona ely impac ing pa ien s in u al a eas and hose
unde going eme gency su ge ies.5 E o s like he Na ional In ec ion Con ol Guidelines aim o s anda dize p e en ion
s a egies and imp o e ou comes.
The mos common pa hogens causing su gical si e in ec ions (SSIs) a e S aphylococcus au eus, including me hicillin-
esis an s ains (MRSA), and Esche ichia coli.1 O he no able o ganisms include coagulase-nega i e s aphylococci,
Klebsiella pneumoniae, Pseudomonas ae uginosa, and En e ococcus species.4 The p e alence o hese pa hogens a ies
based on su gical ype, hospi al se ing, and geog aphic egion.4 In pa icula , S. au eus is equen ly associa ed wi h
o hopaedic and ca dio ascula su ge ies, while g am-nega i e pa hogens like E. coli a e common in gas oin es inal
p ocedu es.7 The eme gence o mul id ug- esis an s ains u he complica es ea men and highligh s he need o
obus in ec ion con ol p ac ices.
Su gical si e in ec ions (SSIs) can lead o signi ican complica ions, including p olonged hospi aliza ion, inc eased
heal hca e cos s, and delayed wound healing.1 Se e e in ec ions may esul in abscess o ma ion, sys emic sepsis, o gan
dys unc ion, o e en dea h, pa icula ly in immunocomp omised pa ien s.8 Ch onic SSIs can lead o implan - ela ed
in ec ions, equi ing su gical ein e en ion o p os he ic emo al. Addi ionally, hey con ibu e o he de elopmen o
an imic obial esis ance, complica ing ea men op ions. P e en ing hese complica ions h ough e ec i e in ec ion
con ol measu es emains c i ical in imp o ing su gical ou comes.
App op ia e use o an ibio ics in su gical p ophylaxis is pi o al in educing he incidence o su gical si e in ec ions
(SSIs).8 Adminis e ing an ibio ics wi hin he ecommended ime ame— ypically wi hin 60 minu es p io o incision—
ensu es adequa e issue concen a ions o p e en mic obial con amina ion du ing su ge y.9 P olonged o
inapp op ia e use o p ophylac ic an ibio ics, howe e , con ibu es o an imic obial esis ance and o e s no addi ional
bene i in p e en ing SSIs.8 S udies emphasize he impo ance o e idence-based guidelines o op imize an ibio ic
selec ion, iming, and du a ion o achie e maximum e icacy while minimizing isks.
The selec ion o an ibio ics o su gical p ophylaxis la gely depends on he ype o su gical wound (clean, clean-
con amina ed, con amina ed, o di y) and he p ocedu e pe o med.9 Clean su ge ies, such as o hopaedic o
ca dio ascula p ocedu es, ypically equi e co e age agains g am-posi i e o ganisms like S aphylococcus au eus,
o en using ce azolin.10 Clean-con amina ed and con amina ed su ge ies, like gas oin es inal o gynaecological
p ocedu es, demand b oade -spec um an ibio ics o a ge g am-nega i e and anae obic pa hogens, such as
ce iaxone o me onidazole.10 Tailo ed an ibio ic egimens based on wound classi ica ion and pa ien -speci ic ac o s
op imize in ec ion p e en ion and minimize esis ance isks.
The inapp op ia e selec ion o an ibio ics o su gical p ophylaxis can esul in se ious consequences, including
ea men ailu e, highe a es o su gical si e in ec ions (SSIs), and inc eased mo bidi y.9 Fo example, inadequa e
g am-nega i e o anae obic co e age in gas oin es inal su ge ies may ail o p e en in ec ions.9 Con e sely, o e use
o b oad-spec um an ibio ics os e s he de elopmen o mul id ug- esis an o ganisms, complica ing u u e
ea men s. Addi ionally, w ong an ibio ic choices may lead o ad e se e ec s like alle gic eac ions o oxici y in
pa ien s.11 E idence unde sco es he impo ance o adhe ing o e idence-based guidelines o a oid hese ou comes.
A s udy on he use o an ibio ics in su gical p ophylaxis is c ucial o add ess he inc easing h ea o su gical si e
in ec ions (SSIs) and he eme gence o an imic obial esis ance.12 Despi e exis ing guidelines, subs an ial a iabili y in
an ibio ic selec ion, iming, and du a ion pe sis s, o en leading o subop imal ou comes.9 Resea ch is essen ial o
e alua e adhe ence o p o ocols, iden i y gaps in p ac ice, and op imize an ibio ic egimens based on e ol ing esis ance
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363
pa e ns and egional needs. So, ou aim o he s udy is o e alua e and op imize he selec ion o an ibio ic o su gical
p ophylaxis in Ahmedabad egion.
2. Ma e ials and Me hods
• S udy Type: This esea ch employed a e ospec i e s udy design, conduc ed ac oss mul iple cen es o ensu e
di e se ep esen a ion and comp ehensi e da a collec ion.
• S udy Cen es Included: Pa ien da a was collec ed om se e al hospi als and clinics loca ed wi hin he
Ahmedabad egion, enabling an expansi e e alua ion o an ibio ic usage o su gical p ophylaxis. [S udy
cen es: SAL Hospi al (Thal ej, Ahmedabad); T eya Su gi ca e (Maninaga , Ahmedabad); A ham Hospi al
(Jodhpu , Ahmedabad); Pa am Ma e ni y and Nu sing Home (Vas al, Ahmedabad); Swas ik O hopaedic
Hospi al (Na oda Pa iya, Ahmedabad)]
• Sample Size: A o al o 602 pa ien s we e included in he s udy, selec ed based on p ede ined c i e ia o
main ain he eliabili y and s a is ical powe o he indings.
• Inclusion C i e ia: Pa ien s unde going a ious su gical p ocedu es who had ecei ed p ophylac ic an ibio ic
he apy we e conside ed eligible o he s udy.
• Exclusion C i e ia: Pa ien s wi h incomple e medical eco ds, missing an ibio ic da a, o lacking ollow-up
documen a ion we e excluded o main ain da a in eg i y.
• S udy Du a ion: The esea ch was conduc ed o e a six-mon h pe iod, allowing su icien ime o assess
pa e ns in an ibio ic p esc ibing and su gical ou comes.
• Da a Collec ion: Rele an pa ien in o ma ion, including demog aphic de ails, ypes o su ge ies, an ibio ics
p esc ibed, dosage o ms, and hospi aliza ion ou comes, was ex ac ed om pa ien eco ds. Da a was hen
ca ego ized and analysed o e alua e adhe ence o p ophylac ic guidelines, an imic obial ends, and mic obial
esis ance.
• S a is ical Analysis: As his s udy was desc ip i e in na u e, da a we e summa ized using basic s a is ical
me hods o illus a e p esc ibing pa e ns and clinical cha ac e is ics. Desc ip i e s a is ics, including
equencies and pe cen ages we e employed o analyse ca ego ical a iables. Tabula ed esul s and g aphical
ep esen a ions (ba cha s, pie cha s) we e used o isually con ey ends ac oss mul iple s udy cen es. No
in e en ial s a is ical es s we e applied, as he p ima y objec i e was o obse e and epo exis ing p esc ibing
p ac ices a he han es ablish causal ela ionships. [No e: Pa ien s ecei ing mul id ug egimens we e coun ed
pe an ibio ic en i y. Hence, o al an ibio ic coun exceeds pa ien coun .]
3. Case Repo Fo m
• Aim o p ojec : E alua ion and Op imiza ion o An ibio ic Selec ion o Su gical P ophylaxis in Ahmedabad
Region
• In es iga o s: Dhan in C. Su ha , Ru ika N. Pa el, Jay N. Joshi
Case no
Gende : Male/Female
Age g oup
o Less han 20 yea s
o 20-30 yea s
o 30-40 yea s
o 40-50 yea s
o Mo e han 60 yea s
Da e o admission: __/__/____
Da e o discha ge: __/__/____
Leng h o hospi aliza ion:
o Less han 3 days
o 3-5 days
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 23(03), 361-376
364
o Mo e han 5 days
3.1. Type o su gical wound
o Clean
o Clean/Con amina ed
o Con amina ed
o Di y
Su ge y: __________________
An ibio ic used o su gical p ophylaxis: ______________
An ibio ic used o pos -ope a i e ca e: ______________
Cul u e and sensi i i y es done: Yes/No Mic oo ganism de ec ed: _____________
4. Resul s
Figu e 1 Dis ibu ion o Pa ien s based on Types o Su gical Wounds
Figu e 2 Gende Dis ibu ion
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Figu e 3 Leng h o Hospi aliza ion
Figu e 4 Cul u e and Sensi i i y Tes ing
Table 1 Mic oo ganisms De ec ed in Cul u e and Sensi i i y Tes s
Mic oo ganism De ec ed in Cul u e and Sensi i i y Tes s
No. o cases
Pe cen age (%)
Bac e oides agilis
5
10.41
Clos idium di icile
5
10.41
En e ococcus aecalis
1
2.08
Esche ichia coli
4
8.33
Helicobac e pylo i
9
18.75
Klebsiella pneumoniae
1
2.08
Pseudomonas ae uginosa
3
6.25
S aphylococcus au eus
16
33.33
S aphylococcus epide midis
3
6.25
S ep ococcus pyogenes
1
2.08
To al
48
100
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Table 2 P ophylac ic An ibio ics
P ophylac ic An ibio ics
An ibio ic Class
An ibio ic sub-class
An ibio ic name
An ibio ic coun
Be a-lac am
1s Gene a ion Cephalospo in
Ce azolin
131
2nd Gene a ion Cephalospo in
Ce u oxime
47
2nd Gene a ion Cephalospo in
Ce o e an
5
2nd Gene a ion Cephalospo in
Ce oxi in
10
3 d Gene a ion Cephalospo in
Ce iaxone
58
3 d Gene a ion Cephalospo in
Ce ixime
108
3 d Gene a ion Cephalospo in
Ce o axime
5
3 d Gene a ion Cephalospo in
Ce ope azone
98
3 d Gene a ion Cephalospo in
Ce podoxime
12
Penicillin
Amoxicillin
20
Penicillin
Pipe acillin
30
Ca bapenem
Me openem
5
To al Be a-lac am
529
Te acycline
-
Doxycycline
3
Fluo oquinolones
2nd Gene a ion Fluo oquinolone
Cip o loxacin
11
3 d Gene a ion
Fluo oquinolone
Le o loxacin
22
To al Quinolones
33
Aminoglycoside
-
Amikacin
2
Glycopep ides
-
Vancomycin
1
Ni oimidazole
-
Me onidazole
19
Lincosamide
-
Clindamycin
19
To al An ibio ics
606
Be a-lac amase inhibi o s
Cla ulana e
8
Tazobac am
30
Sulbac am
98
To al Be a-lac amase inhibi o s
136
Table 3 Pos ope a i e an ibio ics
Pos ope a i e an ibio ics
An ibio ic class
An ibio ic sub-class
An ibio ic name
An ibio ic coun
3 d Gene a ion Cephalospo in
Ce ixime
153
Penicillin
Amoxicillin
41
Penicillin
Pipe acillin
62
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To al Be a-lac am
256
Fluo oquinolones
2nd Gene a ion Fluo oquinolone
Cip o loxacin
6
3 d Gene a ion
Fluo oquinolone
Le o loxacin
52
To al Fluo oquinolones
58
Ni oimidazole
-
Me onidazole
79
Oxazolidinone
-
Linezolid
22
Mac olides
-
Azi h omycin
5
To al An ibio ics
420
Be a-lac amase inhibi o s
Cla ulana e
161
Tazobac am
62
To al Be a-lac amase inhibi o s
223
Figu e 5 An ibio ics Used o Su gical P ophylaxis in Clean Wounds
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Figu e 6 An ibio ics Used o Su gical P ophylaxis in Clean/Con amina ed Wounds
Figu e 7 An ibio ics Used o Su gical P ophylaxis in Con amina ed Wounds
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Figu e 8 An ibio ics Used o Su gical P ophylaxis in Di y Wounds
Figu e 9 An ibio ics Used o Pos -ope a i e Ca e in Clean Wounds
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[27] Badge HM, Chu ches T, Naylo JM, Xuan W, A ms ong E, e al. Non-compliance wi h clinical guidelines inc eases
he isk o complica ions a e p ima y o al hip and knee join eplacemen su ge y. PLOS ONE. 2021;16(11):
e0260146.
[28] Rome o L. Su gical wound classi ica ion. Ope Re Su g. 2023; 1:59–62.
[29] Hassan S, Chan V, S e ens J, S upans I. Fac o s ha in luence adhe ence o su gical an imic obial p ophylaxis
(SAP) guidelines: a sys ema ic e iew. Sys Re . 2021; 10:29.
[30] Ma inez-Sobal a o JV, Pe ei a Júnio AA, Pe ei a LB, Baldoni AO, Ce on CS, Reis TM. An imic obial s ewa dship
o su gical an ibio ic p ophylaxis and su gical si e in ec ions: a sys ema ic e iew. In J Clin Pha m. 2022;
44:301–19.
[31] Se ah IA, Che y S, Yamoah P, Bangalee V. The impac o an imic obial s ewa dship in e en ions on app op ia e
use o su gical an imic obial p ophylaxis in low- and middle-income coun ies: a sys ema ic e iew. Sys Re .
2024; 13:306.
[32] S an o d Heal h Ca e. SHC su gical an imic obial p ophylaxis guidelines. S an o d An imic obial Sa e y and
Sus ainabili y P og am; 2025 Jan 23. S an o d (CA).
[33] Ame ican Socie y o Heal h-Sys em Pha macis s, In ec ious Diseases Socie y o Ame ica, Su gical In ec ion
Socie y, Socie y o Heal hca e Epidemiology o Ame ica. Clinical p ac ice guidelines o an imic obial
p ophylaxis in su ge y. ASHP The apeu ic Guidelines. Re ised 2025.
[34] T ipa hi KD. Essen ials o medical pha macology. 8 h ed. New Delhi: Jaypee B o he s Medical Publishe s; 2018.
[35] Shanbaug TV. Pha macology o medical g adua es. 3 d ed. Else ie ; 2015.
[36] Biology Insigh s. Me onidazole: mechanism, ac i i y, pha macokine ics, and in e ac ions. 2024 Oc 23.
[37] Cha e nsuk M, Tun u anakul S, Jamjum a L, Cha eonsil B. E alua ion o p eope a i e an ibio ic p ophylaxis in
clean-wound gene al su ge y p ocedu es: a p opensi y sco e-ma ched coho s udy a a egional hospi al. BMC
Su g. 2024; 24:294.
[38] Babu SV. P e en ing su gical si e in ec ion and sa e usage o an ibio ics in o hopaedic su ge y. Na l J Clin O hop.
2020;4(2):26–9.
[39] Rohilla R, Gup a M, Anish TS, e al. Mul ip onged in e en ions o educe su gical si e in ec ions: a mul icen e
implemen a ion esea ch p o ocol. PLOS ONE. 2025.
[40] Na ional Ins i u e o Heal h and Ca e Excellence. Su gical si e in ec ions: p e en ion and ea men . NICE
guideline NG125. 2019 Ap 11 [upda ed 2020 Aug 19].
