EVALUATION OF THE COMPARATIVE EFFECTIVENESS OF VARIOUS ANTIBIOTIC PROPHYLAXIS PROTOCOLS IN REDUCING POSTOPERATIVE SURGICAL SITE INFECTIONS IN TYPHOID ILEAL PERFORATION SURGERIES
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Keywords
Typhoid ileal perforation, surgical site infections, antibiotic prophylaxis, Ceftriaxone, Metronidazole, Piperacillin-Tazobactam, gastrointestinal surgery
Abstract
Background: Typhoid ileal perforation is a severe complication requiring prompt surgical intervention, often accompanied by the risk of postoperative surgical site infections (SSIs). Antibiotic prophylaxis is critical in preventing SSIs, but the optimal regimen for such surgeries remains debated.
Objective: This study aimed to evaluate the comparative effectiveness of three antibiotic prophylaxis protocols—Ceftriaxone (Protocol A), Ceftriaxone + Metronidazole (Protocol B), and Piperacillin-Tazobactam (Protocol C)—in reducing the incidence of SSIs following typhoid ileal perforation surgeries.
Materials and Methods: A cross-sectional study was conducted over six months at the Department of General Surgery, People’s University of Medical & Health Sciences, Shaheed Benazirabad, involving 180 patients aged 18 years and older. Patients with known allergies to the antibiotics, chronic infections, or prior abdominal surgeries were excluded. Data were collected through structured questionnaires, capturing demographic information, clinical parameters, antibiotic protocols used, and postoperative outcomes. The incidence of SSIs served as the primary outcome measure. Data were analyzed using Microsoft Excel 2016 and SPSS v21.0, with chi-square tests and logistic regression used to assess statistical significance (p < 0.05).
Results: The study included 120 males (66.7%) and 60 females (33.3%). Protocol B (Ceftriaxone + Metronidazole) demonstrated the lowest SSI rate (16.7%), followed by Protocol C (Piperacillin-Tazobactam) with 16.7%. Protocol A (Ceftriaxone) had the highest SSI rate (33.3%), with a statistically significant association (p = 0.04) compared to Protocol B. No significant differences were found between Protocols B and C. Logistic regression revealed that patients receiving Protocol A were 2.5 times more likely to develop SSIs than those on Protocol B (OR = 2.5, p = 0.03). Age, gender, and comorbidities showed no significant association with SSIs (p > 0.05).
Conclusion: This study highlights the superior effectiveness of combination therapy with Ceftriaxone and Metronidazole (Protocol B) in preventing SSIs compared to Ceftriaxone monotherapy. While Piperacillin-Tazobactam (Protocol C) performed comparably to Protocol B, broader-spectrum antibiotics may not offer a distinct advantage in regions with low resistance.
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Dr Mujeeb Ur Rehman Sahito
MBBS, MS (General Surgery), MS (Urology), M. Phil (Anatomy), Associate Professor Department of Anatomy, Peoples University of Medical and Health Sciences for Women, Nawabshah SBA
Dr Naeem Ul Karim Bhatti
MBBS, MS (General Surgery), Assistant Professor, Department of Surgery, Peoples University of Medical & Health Sciences for Women (PUMHSW), Nawabshah SBA
Dr Shahnawaz Abro
MBBS, MS (General Surgery), Associate Professor, Department of Surgery, Indus Medical College, Tando Muhammad Khan.
Dr Sajjad Hussain Qureshi
MBBS, MS (General Surgery), Assistant Professor, Department of Surgery, Peoples University of Medical & Health Sciences for Women (PUMHSW) Nawabshah SBA
Dr. Syed Kashif Ali Shah
MBBS, MS (General Surgery), Associate Professor, Department of Surgery, Peoples University of Medical & Health Sciences for Women (PUMHSW), Nawabshah SBA
Dr Shahida Baloch
MBBS, MS (General Surgery), Assistant Professor, Department of Surgery, Peoples University of Medical & Health Sciences for Women (PUMHSW), Nawabshah SBA
Dr Navin Kumar
MBBS, (MS General Surgery), Postgraduate Resident at Peoples University of Medical & Health Sciences for Women (PUMHSW), Nawabshah SBA