IS SHORTENED SURGICAL ANTIMICROBIAL PROPHYLAXIS THE NEW NORM?

• DOI: 10.37572/EdArt_3006260557

• Palavras-chave: antimicrobial prophylaxis; antimicrobial resistance; antimicrobial stewardship; surgical site infection; surgeons’ perceptions.

• Keywords: antimicrobial prophylaxis; antimicrobial resistance; antimicrobial stewardship; surgical site infection; surgeons’ perceptions.

• Abstract:

  Surgical antimicrobial prophylaxis (SAP) is a major contributor to hospital antimicrobial use and an important universal target for antimicrobial stewardship (AMS). International guidance supports single-dose prophylaxis or discontinuation within 24 hours for most surgical procedures to reduce unnecessary antimicrobial exposure and antimicrobial resistance (AMR) risk. In 2021, Ireland introduced a national Surgical Antibiotic Prophylaxis Duration Position Paper reinforcing these principles; however, surgeons’ perceptions toward shortened SAP remain incompletely understood. An opportunistic qualitative survey was therefore conducted among surgeons attending a national surgical conference to assess attitudes, knowledge, and prescribing behaviours relating to SAP duration and antimicrobial selection. Fifty-eight surgeons participated, including consultants (17%), registrars (57%), and senior house officers (26%), representing Gastro-intestinal/General Surgery (60%), Orthopaedics (17%), Urology (12%), and Vascular Surgery (10%). Despite only 5% being aware of the national position statement, acceptance of shortened SAP duration was high, with 83% reporting SAP duration of ≤24 hours in routine practice, including 17% favouring single-dose prophylaxis and 66% prescribing prophylaxis for 24 hours. Duration of prophylaxis was reportedly unaffected by the presence of surgical drains for 67% of respondents. Most surgeons (81%) reported reliance on local antimicrobial guidelines or clinical microbiologist advice for antimicrobial selection. Concurrent metronidazole prescribing alongside co-amoxiclav or piperacillin-tazobactam was reported as routine practice by 31% of respondents. Overall, surgeons demonstrated favourable attitudes toward shortened SAP duration despite limited awareness of formal national guidance. These findings mirror improving institutional antimicrobial point prevalence survey metrics and suggest increasing integration of stewardship principles into surgical practice; however, optimisation of antimicrobial selection remains necessary, particularly regarding unnecessary anaerobic duplication.