An Audit of Antibiotic Prophylaxis for Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy is a commonly performed surgical procedure for the treatment of symptomatic gallstones. Antibiotic prophylaxis is recommended to prevent surgical site infection (SSI) and other related complications and has been known to lower the incidence of postoperative infection in surgeries. The American Society of Health-System Pharmacists (ASHP) guideline summarizes current data on the appropriate use of antibiotic for surgical prophylaxis.

Objective: The objective of this study is to assess and audit the use of antibiotics for laparoscopic cholecystectomy surgeries in a tertiary care centre according to the recommendation of ASHP guidelines.

Methods: A retrospective audit was conducted and medical records of patients who underwent laparoscopic cholecystectomy between August 2022 to February 2023 in the surgical wards of a private hospital in Mira road, were studied. Antibiotic indication and choice, dose, dosing interval, route of administration, and timing of first administration and duration of prophylaxis were compared with the ASHP guideline recommendations.

Results: A total of 100 patients with the age of >18 years were retrospectively studied. About 87 % of procedures had full compliance with all guideline recommendations. The variables with least compliance were “Appropriate Dose” (87% compliance rate) and “Appropriate initiation time of prophylaxis” (97% compliance rate). The variables with most compliance were Appropriate Agent used (100%), Appropriate Duration of Prophylaxis (100%), Appropriate administration route (100%), and Appropriate decision regarding use and non-use of antibiotic prophylaxis (100%).

Conclusion: This audit highlights the need for improved adherence to guidelines regarding antibiotic prophylaxis in laparoscopic cholecystectomy. The study revealed that most of the prescribed antibiotics for surgical prophylaxis in the hospital are in accordance with standard treatment guideline. The density of antimicrobial use in the hospital for preoperative antimicrobial prophylaxis is as indicated/optimal.