Submission ID 131746
| Issue/Objective | Surgical site infections (SSIs) represent a significant source of postoperative morbidity, prolonged hospitalization, and increased healthcare costs, particularly in low- and middle-income countries (LMICs). In these settings, challenges such as limited infection prevention infrastructure, inadequate microbiological diagnostic capacity, and inconsistent adherence to clinical guidelines contribute to poor outcomes. Inappropriate antibiotic prescribing, especially the overuse of broad-spectrum agents for both prophylaxis and treatment, remains a key driver of antimicrobial resistance. Despite the growing global emphasis on antimicrobial stewardship, there is limited context-specific evidence from Liberia evaluating antibiotic utilization patterns in surgical care. This study aimed to assess antibiotic prescribing practices for SSIs and evaluate their alignment with established guideline recommendations, providing evidence to strengthen antimicrobial stewardship and surgical care policies in Liberia. |
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| Methodology/Approach | A prospective cross-sectional study was conducted among 128 adult postoperative patients at JFK Medical Center-Liberia; September-November 2022. Data were collected using structured chart reviews, patient interviews, and standardized clinical wound assessments. Antibiotic prescriptions for prophylaxis and treatment were systematically evaluated for appropriateness in terms of indication, spectrum, timing, and duration, and compared against international evidence-based guidelines. |
| Results | The prevalence of SSIs was 37.8% (48/128), reflecting a substantial burden of postoperative infection. Ceftriaxone was the most commonly prescribed antibiotic for prophylaxis (66.4%), followed by ampicillin (21.9%) and metronidazole (4.7%). For treatment, ceftriaxone (92.1%) and metronidazole (90.6%) were predominantly used, frequently in combination regimens. Broad-spectrum antibiotics were extensively utilized across both prophylactic and therapeutic indications, with minimal variation based on wound classification or infection severity. A considerable proportion of prescriptions were not aligned with guideline recommendations, particularly with respect to prolonged duration of prophylaxis and lack of de-escalation strategies. Notably, there was no evidence of microbiological culture or sensitivity testing guiding antibiotic selection. |
| Discussion/Conclusion | This study demonstrates a high burden of SSIs and identifies significant gaps in antibiotic prescribing practices, characterized by inappropriate reliance on broad-spectrum agents and poor adherence to international guidelines. These findings underscore the urgent need for implementation of structured antimicrobial stewardship programs, development of locally adapted prescribing protocols, and strengthening of microbiological diagnostic services. Addressing these gaps is critical to optimizing antibiotic use, improving surgical outcomes, and mitigating the escalating threat of antimicrobial resistance in Liberia and similar resource-constrained settings. |
| Presenters and Affiliations | Elvis J Davis John F. Kennedy Medical Center Elvis J Davis John F. Kennedy Medical Center |
