Title : Compliance with surgical antibiotic prophylaxis guidelines in bowel resection surgery: A retrospective audit
Abstract:
Introduction: Perioperative antibiotic prophylaxis is essential in reducing surgical site infections (SSI) and postoperative morbidity following bowel surgery. Institutional and national guidelines emphasise appropriate antibiotic selection, timing, dosing, and intraoperative redosing. While initial antibiotic administration is often prioritised, compliance with redosing recommendations is less consistently achieved.
Aim: To assess compliance with surgical antibiotic prophylaxis guidelines in patients undergoing bowel resection and to explore associations between antibiotic non-compliance and postoperative outcomes.
Methods: A retrospective observational audit was conducted at Mater Hospital including adult patients who underwent elective or emergency bowel resection between 1 January 2024 and 1 January 2025. Data collected included demographics, comorbidities, surgical characteristics, antibiotic selection, timing relative to incision, dosing, intraoperative redosing, and concordance with institutional and national guidelines. Primary outcomes were SSI and length of stay. Secondary outcomes included systemic inflammatory response syndrome (SIRS), sepsis or septic shock, ICU admission, acute kidney injury (AKI), unplanned readmission, and mortality.
Results: Sixty-seven patients were included. Intraoperative antibiotics were administered in 97% of cases, with 95% given within 60 minutes prior to incision; most timing breaches occurred in emergency cases (80%). Guideline-compliant antibiotic selection occurred in 87.7% of cases, and initial dosing was appropriate in all patients. Forty-four patients met criteria for intraoperative redosing, of whom 68.2% were appropriately redosed. Overall, only 41.8% of patients received fully guideline-concordant prophylaxis.
The non-compliant cohort demonstrated higher rates of SIRS, sepsis or septic shock, ICU admission, AKI, and mortality. Although SSI appeared higher in patients receiving appropriate dosing and redosing, this group had greater illness severity, including planned ICU admissions. Among patients requiring redosing, no meaningful difference in SSI rates was observed between appropriately and inappropriately redosed groups. SSI occurred more frequently in patients with hospital stay ≥15 days, with no infections observed in stays <7 days.
Conclusion: Compliance with initial antibiotic timing and dosing in bowel resection surgery was high; however, intraoperative redosing compliance was suboptimal. Antibiotic non-compliance was associated with worse clinical outcomes. Targeted quality improvement initiatives focusing on redosing practices may enhance patient safety and postoperative outcomes.
