Observational studyThe British journal of surgery2024
An observational cohort study on the effects of extended postoperative antibiotic prophylaxis on surgical-site infections in low- and middle-income countries.
Observational study in The British journal of surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.
- Synthesizing evidence to guide the design and implementation of effective strategies for discontinuing postoperative antibiotic prophylaxis in surgical settings: an umbrella review post-WHO 2018 recommendations.Systematic reviews · 2025Pooled it
- Safety of routine antimicrobial prophylaxis for surgery (SAPPHIRE): a prospective multi-centre cohort study.EClinicalMedicine · 2026Article
- From suspected necrotizing fasciitis to diagnosed drug-induced fever: a diagnostic maze and reflections on anti-infection management in a case of postoperative fever after femoral fracture.Frontiers in medicine · 2026Article
- Article
- Tackling the disparities in surgical site infections and related antimicrobial resistance in low- and middle-income countries.Surgery in practice and science · 2025Review
- Antibiotics consumption in neurosurgery versus appendectomy: a call for antibiotic stewardship initiatives.Medicine and pharmacy reports · 2025Article
- Surgical prophylaxis in Haydom Lutheran Hospital, Tanzania - learning from a point prevalence survey.Infection prevention in practice · 2025Article
- Infections do not play fair: the Charlson-Age Comorbidity Index reveals sex-specific risk in laparotomy patients in an LMIC.Trauma surgery & acute care open · 2025Article
- Surgical Antibiotic Prophylaxis Used in A University Clinics Hospital and Antibiotic Costs: A 3-year Survey.Current therapeutic research, clinical and experimental · 2025Article
- High Prevalence of Antimicrobial Prescribing Among Public Health Facilities in Central Uganda: Findings from Point Prevalence Survey.Infection and drug resistance · 2025Article
- A Prospective Quality Improvement Program to Reduce Prolonged Postoperative Antibiotic Prophylaxis in Ethiopia.Surgical infections · 2024Article
- Qualitative drivers of postoperative prophylactic antibiotics use and resistance in Ethiopia.BMC health services research · 2024Article
- Where do the pathogens that cause surgical site infections come from?Science translational medicine · 2024Review
- Article
Corrections and comments
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Authors and funding
1 author.
Funding
Abstract
backgroundWorldwide, approximately one in six inpatient antibiotic prescriptions are for surgical-infection prophylaxis, including postoperative prophylaxis. The WHO recommends against prolonged postoperative antibiotics to prevent surgical-site infection. However, in many low- and middle-income countries, postoperative antibiotic prophylaxis is common due to perceptions that it protects against surgical-site infection and data informing recommendations against antibiotic administration are largely derived from high-income countries. The aim of this study was to describe postoperative antibiotic-prescribing patterns and related surgical-site infection rates in hospitals in low- and middle-income countries.
methodsPatients from 19 hospitals in Ethiopia, Madagascar, India, and Bolivia with wound class I and II operations were included. Data on antibiotic administration, indication, surgical-site infection, length of hospital stay, and adherence to perioperative infection-prevention standards were collected by trained personnel. The association between postoperative antibiotic prophylaxis for greater than or equal to 24 h and surgical-site infection was analysed via modified robust Poisson regression, controlling for patient and procedural factors and degree of adherence to perioperative infection-prevention practices.
resultsOf 8714 patients, 92.9% received antibiotics for prophylaxis after surgery and 27.7% received antibiotics for greater than or equal to 24 h. Patients receiving postoperative prophylaxis for greater than or equal to 24 h did not have lower surgical-site infection rates (Relative risk 1.09 (95% c.i. 0.89 to 1.33); P = 0.399), but the length of hospital stay was 1.4 days longer (P < 0.001).
conclusionProlonged postoperative antibiotics did not reduce surgical-site infection, but pervasive use was associated with a longer length of hospital stay, in resource-limited healthcare systems. With the growing threat of antimicrobial resistance, surgical initiatives to implement antimicrobial stewardship programmes in low- and middle-income countries are critical.
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