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\def\citeauthor{~Saurabh~Bhan~Singh,
              ~Harsh~Sonar,
              ~Amit~Ashutosh~Prusty,
              ~Sugreev~Dwivedi~Anuj,
              ~Tejas~B~Patel,
              ~Lavanya~S}
\def\citetitle{\textbf{Guideline Preparation of Antimicrobial Prophylaxis in Surgery Department at a Tertiary Health Care Setting}}
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\def\RunningAuthor{Saurabh Bhan Singh et al.}
\firstPage{40}
\articleType{Original Article}
\receivedDate{07 Jan 2022}
\acceptedDate{26 Jan 2022}
\revisedDate{24 Jan 2022}
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\journalIssue{1}
\copyrightYear{2022}
\eISSN{2583-0953}
\journalDoi{10.26452/ijcpms.v2i1.268}
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\def\journalTitle{International Journal of Clinical Pharmacokinetics and Medical Sciences}

\title{\textbf{Guideline Preparation of Antimicrobial Prophylaxis in Surgery Department at a Tertiary Health Care Setting}}
\author{Saurabh~Bhan~Singh\textsuperscript{*}\textsuperscript{1},  
            Harsh~Sonar\textsuperscript{1},  
            Amit~Ashutosh~Prusty\textsuperscript{1},  
            Sugreev~Dwivedi~Anuj\textsuperscript{2},  
            Tejas~B~Patel\textsuperscript{3}, 
            Lavanya~S\textsuperscript{4}~\\[5pt]{\textsuperscript{1}Department of Pharmacy Practice, Parul Institute of Pharmacy, Parul University, Vadodara-391760, Gujarat, India}~\\{\textsuperscript{2}Department of Pharmacy Practice, Parul Institute of Pharmacy and Research, Parul University, Vadodara-391760, Gujarat, India}~\\{\textsuperscript{3}Department of General Surgery, Parul Sevashram Hospital, Vadodara-391760, Gujarat, India}~\\{\textsuperscript{4}Department of Pharmacy Practice, PSG College of Pharmacy, Peelamedy, Coimbatore-641004, Tamil Nadu, India}}

\begin{abstract}
Surgical site infections are a problem that affects people all over the world. Wound infections, despite being curable, remain to inflict major morbidity, high death rates, and financial strain on national budgets and patient care. Unnecessary surgical antimicrobial prophylaxis has a positive and negative impact on patients' quality of life. The major risk factors for surgical site infections were investigated in this study. Between October 2021 and March 2022, a 6-month institution-based retrospective cross-sectional research was conducted. A rigorous random sample approach was employed to choose 227 surgical cases. Infections at the surgical site accounted for 46.7 percent of all infections. In 188 (82.8\%) of the surgical cases, prophylaxis was provided. For 151 patients, prophylaxis was recommended (66.5 percent). Only 143 (94.7\%) of them were given prophylactic antibiotics. Seventy-four operations (78.4 percent) were adequately suggested. A total of 13.7 percent of patients used surgical antibacterial prophylaxis. The worldwide surgical site infection prevention guideline and the practice of surgical antimicrobial prophylaxis were significantly uneven. The inappropriate selection of antimicrobial drugs was the most flagrant violation of the standards. Surgical antibacterial prophylaxis was quite common, and therefore deserves special attention. The duration of postoperative prophylaxis should not exceed 24 hours. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Surgical Site,\newline Infections,\newline Antimicrobial Prophylaxis,\newline Post-Operative Prophylaxis
\end{keywords}
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\makeatletter{\raggedright{\Large$^\ast$}Corresponding Author\par Name:\ Saurabh~Bhan~Singh~\\ Phone:\ ~\\  Email:\ Saurabhsingh199757@gmail.com
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\section{Introduction}
Infections related with healthcare, such as surgical site infections (SSIs), are linked to higher morbidity and death rates across the world. Antibiotics are used in surgical antimicrobial prophylaxis (SAP) to prevent infections at the surgical site. Before surgery, a sufficient amount of antibiotic is administered to the tissues. The American Society of Health-System Pharmacists (ASHP) has issued therapeutic guidance to help reduce or control the morbidity and mortality associated with SSIs, with an emphasis on supporting appropriate antibiotic selection as well as the duration and frequency of SAP.

Antibiotics are antibiotics that are used to treat bacterial infections \unskip~\cite{1448053:25224119}. Antibiotic prophylaxis, a very concise course of antibiotics started the day before the outset of surgical procedures in clean, clean-contaminated, and dirty procedures, is recommended to reduce postoperative infection. Prophylaxis is the prevention of infection and is divided into three categories: primary, secondary, and eradication. Primary prophylaxis refers to the prevention of initial infection. The prevention of recurrence or reactivation of a formerly active infection is known as secondary prophylaxis. Eradication is defined as the removal of a colonized organism in order to prevent the spread of infection \unskip~\cite{1448053:25224123}.

The risk of infection without antibiotics, as well as the morbidity and expense of an infectious consequence, must all be addressed when determining whether a procedure is "prophylaxis recommended." A taxonomy that categorizes procedures based on the amount of microbial contamination that is commonly associated with that technique and the risk of infection makes it easier to address these concerns. The criteria are based on clinical information specified by the National Academy of Sciences, National Research Council (NRC), Division of Medicine, and Ad Hoc Committee on Trauma \unskip~\cite{1448053:25224114}. Infection rates vary substantially between classes, ranging from less than 2\% for clean treatments (such as a breast biopsy) to more than 40\% for unclean procedures (colon perforation with diffuse faecal contamination). In all operations classed as clean-contaminated, contaminated, or unclean, antibiotic prophylaxis is widely acknowledged to be required. Antibiotics used for prophylaxis must be effective against the organisms that are likely to be present at the surgical site. The antibiotic should be chosen based on the local resistance trend. During surgery, the initial line of defense should be a narrow-spectrum, less costly antibiotic \unskip~\cite{1448053:25224114}.

Antimicrobial prophylaxis techniques should be ascertained based on the type of post-operative infections that might occur, as well as operation classifications based on levels of contamination in individual operative fields. This technique may require the cautious selection of prophylactic medications for suspected contaminating bacterial species in each operational organ, as well as individualized dosing regimens for each surgery \unskip~\cite{1448053:25224122}. Antibiotics should be given intravenously as a preventative measure before any surgical procedure \unskip~\cite{1448053:25224115}. The risk of surgical site infection starts with the incision. The time it takes antibiotics to reach an effective concentration in a specific tissue needs to reflect the pharmacokinetic profile and route of administration. Prophylactic administration more than three hours after the operation begins significantly reduces its effectiveness. It should be administered just before or just after the start of the operation for maximum effect. In most cases, a single dose of antibiotic for prophylactic being used is the same as a therapeutic dose. The importance of surgical antibiotic prophylaxis in reducing the incidence of SSI following elective surgery is proportional to the severity of the consequences of SSI. However, for the majority of operations, prophylaxis only reduces short-term morbidity. Infection of a surgical wound lengthens the hospital stay. As a result, prophylaxis has the potential to reduce hospital stay. Infections that arise in the wound caused by an invasive surgical operation are known as Surgical Site Infections (SSI). One of the most common causes of Health-Care-Associated diseases is sexually transmitted infections (SSIs) (HCAIs).

In the United States alone, an estimated 27 million surgical operations are done each year. The Centers for Disease Control and Prevention (CDC) developed the National Nosocomial Infections Surveillance (NNIS) system in 1970 to track reported trends in nosocomial infections in U.S. acute care hospitals. SSIs are the third most often reported nosocomial infection, accounting for 14 percent to 16 percent of all nosocomial infections among hospitalized patients, according to NNIS system statistics. Advances in infection control procedures include improved operating room ventilation, sterilizing technologies, barriers, surgical technique, and the availability of antibiotic prophylaxis. SSIs continue to be a major source of morbidity and death among hospitalized patients despite these efforts. The advent of antimicrobial-resistant infections, as well as an increase in the number of surgical patients who are older and/or have a variety of chronic, debilitating, or immune-compromising medical conditions, might explain this. Furthermore, the number of prosthetic implant and organ transplant surgeries has risen. A methodical but reasonable strategy must be adopted to reduce the risk of SSI, with the awareness that risk is impacted by patient, operation, staff, and hospital features \unskip~\cite{1448053:25224113}. Antimicrobial resistance trends can diverge regional level and even within a single community's hospitals.

Antibiotic overuse contributes to antimicrobial resistance, putting patients at higher risk of carrying and contracting resistant bacteria. Infections are the most common reason for patients seeking medical help and receiving antibiotics. Antibiotics used inappropriately or indiscriminately can raise healthcare costs by raising drug prices, increasing toxicity, increasing resistance, and raising laboratory costs. Antibiotic prophylaxis is still a problem in some hospitals. Respiratory tract infections cause the majority of deaths in developing countries with high poverty rates and poor medical care. Antimicrobial resistance among pathogens has been documented in many regions and has now become a major global challenge. Antibiotic combinations are frequently used to broaden the scope of coverage for empiric therapy and to achieve synergistic activity. Antibacterial medications are widely regarded as the greatest scientific breakthrough of the twentieth century. Antibiotics are a combination of the Greek words anti ("against") and bios ("life"). The first antimicrobial was discovered in the mid-20th century, and between 1960 and 1980, many new molecules were discovered. The "golden era of antibiotics" saw a dramatic decrease in infection-related mortality. Since the 1980s, few new classes of molecules have been discovered, and funding for antimicrobial research has decreased, resulting in an increase in deaths due to resistant infections; mortality due to nosocomial infections is now four times that of road traffic accidents, preventing the emergence of resistance \unskip~\cite{1448053:25224118}.

The majority of antimicrobial decisions are based on guesswork and are made before the pathogen's identity and susceptibility pattern are known. Many factors influence empiric antimicrobial selection, but local antimicrobial susceptibility patterns of commonly isolated bacteria are the most important. Antimicrobial resistance has been steadily increasing in many institutions, and resistance rates vary by geographic location and patient demographics, so having current cumulative antimicrobial susceptibility data on hand is critical. These data are also needed for assessing infection-control measures and antimicrobial-resistance containment strategies, optimizing microbiological susceptibility testing and reporting methodologies, and directing Pharmacy and Therapeutics Committee formulary decisions. Other strategies, such as identifying isolates with specific antibiotic resistance characteristics \unskip~\cite{1448053:25224118}, that are not discussed in the CLSIM39-A3 handbook might be utilized to assess susceptibility test results.

Variable surgical prophylaxis practices have been widely reported; the variation in procedures could be associated with significant variation in published guidelines, particularly regarding the timing and duration of antibiotic prophylaxis, lack of consensus among surgeons with the guideline, and low awareness and allocation of the guidance \unskip~\cite{1448053:25224118}. During certain clean surgery process and protocols that involve incision of non-sterile mucosal surfaces, antimicrobial prophylaxis is recommended (oral mucosa, respiratory tract, gastrointestinal tract and female genito-urinary tract). Where ever possible, local departmental protocols should be followed. On the single dose/pre-medication section of the prescription chart, antimicrobials should be prescribed \unskip~\cite{1448053:25224119}.
    
\section{METHODOLOGY}
\textbf{Study Setting}

Vadodara's tertiary care hospital was the site of the research. Medical, outpatient, paediatrics, gynaecology, surgical, ophthalmic, dermatology, psychiatry, and multidrug resistance are some of the departments.

\textbf{Study Design and Period}

A 6-month retrospective cross-sectional study was conducted at the institution between October 2021 and March 2022.

\textbf{Study Population}

The study population consisted of patients who underwent surgical procedures at the surgical ward during the study period. 

\textbf{Sample Size}

A single population proportion formula, 227, was used to determine sample size, and a simple random sampling technique was used.

\textbf{Inclusion and Exclusion Criteria}

This study included patients of both genders with clean, clean contaminated and contaminated wounds. Patients with dirty/infected wounds, as well as those who had previously been infected and treated with antibiotics, were excluded. To distinguish between preventive and therapeutic courses, this was done. Patients with insufficient medical records and illegible handwriting were also removed.

\textbf{Surgical Antimicrobial Prophylaxis Use Evaluation Protocol}

The following parameters were compared to ASHP recommendations \unskip~\cite{1448053:25224117}  to determine whether SAP practice guideline recommendations were followed: indication, choice of antimicrobial agent, dose, route of administration, time of administration of the first preoperative dose, and duration of postoperative prophylaxis. The following criteria for evaluating SAP usage were established based on ASHP recommendations:

1. Indications were classified as either


  
  \begin{enumerate}
  \item \relax Appropriate {\textendash} if prophylaxis was advised and given, or 
  \item \relax Inappropriate {\textendash} if no prophylaxis was given.
  \end{enumerate}
  2. Inappropriate - if prophylaxis was suggested but not administered, or if it was administered but not necessary. Based on the range of coverage and germs most likely to be found at the surgical site, antimicrobial agents were classified as follows:


  
  \begin{enumerate}
  \item \relax Appropriate - adequately protected against microorganisms.
  \item \relax Narrow {\textendash} did not cover the full range of germs expected; broad or superfluous
  \item \relax Combination {\textendash} covered microorganisms at the surgical site more than expected.
  \end{enumerate}
  3. First preoperative dosage administration time:


  
  \begin{enumerate}
  \item \relax Appropriate {\textendash} if given 30{\textendash}60 minutes before incision.
  \item \relax Too soon {\textendash} if taken more than 1 hour before the incision.
  \item \relax If given between 0 and 29 minutes before incision, it is considered late.
  \end{enumerate}
  4. Route:


  
  \begin{enumerate}
  \item \relax Appropriate {\textendash} if administered intravenously.
  \item \relax Inappropriate if given via a method other than IV.
  \end{enumerate}
  5. Postoperative prophylaxis duration:


  
  \begin{enumerate}
  \item \relax Appropriate {\textendash} if given within 24 hours of operation completion.
  \item \relax Inappropriate if more than 24 hours have passed since surgery.
  \end{enumerate}
  The other criteria were not assessed in surgical situations when the reason for prophylaxis was not appropriate. Each antimicrobial agent was evaluated independently in surgical cases where more than one antimicrobial agent was provided for a single procedure. In such circumstances, if one of the agents was found to be used outside of the guidelines, the entire preventive course was deemed ineffective, as this could lead to antimicrobial resistance. The cases in which prophylaxis was indicated and prescribed with appropriate choice of antibacterial agent, dose, route of administration, time of administration of the first preoperative dose, and length of time of postoperative prophylactic treatment, as well as the cases in which prophylaxis was not indicated and not administrated, were used to determine overall compliance with guideline recommendations. Finally, SAP was deemed compliant if it met all of the foregoing criteria for all of the medications prescribed. Missing data was defined as data that was missing for a specific parameter.

\textbf{Data Collection and Statistical Analysis}

Disease information, such as type of surgery, type of procedure, and wound classification, occurrence and time of onset, and antimicrobial prophylaxis utilization review, including indication, name of antimicrobials prescribed as prophylactic agent, time of administration, dose, route of administration, and duration of postoperative prophylaxis are all included on the data collection form. The data collecting form was correctly created and pretested on 10 patient charts in the hospital to ensure data quality. During data management, storage, and analysis, all finalized formats were checked for completeness and consistency.

The categorical variables were described using univariate analysis (frequency and percentage distributions of different characteristics). Continuous variables were described using means and standard deviations. Variables in the multivariate logistic model with a p-value of less than 0.05 were declared statistically significant factors after the statistical analysis.
    
\section{RESULTS AND DISCUSSION}
This study comprised a total of 227 surgical case records of patients who matched the inclusion criteria. The bulk of the patients, 146 (64.3\%), were men, as shown in Figure~\ref{f-2b9741ef9d8e}. The research population's mean age was 40.58 19.6 years (mean SD), as shown in Figure~\ref{f-d3139f61f190}. Nearly half of the 109 patients (48 percent) were above the age of 40. Elective surgical treatments were performed on 162 (71.4\%) of the patients in Figure~\ref{f-d37836b4854c}. Type of surgery procedure was represented in Figure~\ref{f-901dbe61804f}. Wound classification was given in Table~\ref{tw-bb1ddee52b0a}. Co-morbid conditions incidence was represented in Table~\ref{tw-387fbb53b6c2}. Types of co-morbidities were represented in Figure~\ref{f-22c464e40201}. Indication of Surgical Antibiotic Prophylaxis was given Table~\ref{tw-518251e0dcdb}. Antimicrobials Prescribed as Preoperative (n = 114) and Postoperative (n = 154) Prophylactic Agents given in Figure~\ref{f-a330b7075c24}. Duration of postoperative prophylaxis was given in Table~\ref{tw-7136c4e33c1f}.


\bgroup
\fixFloatSize{images/7b0ad458-2a9b-4b21-a7d3-f27c9d31df83-upicture1.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/7b0ad458-2a9b-4b21-a7d3-f27c9d31df83-upicture1.png}{\includegraphics{images/7b0ad458-2a9b-4b21-a7d3-f27c9d31df83-upicture1.png}}{}
\makeatother 
\caption{\boldmath {Gender Classification}}
\label{f-2b9741ef9d8e}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/031259b9-bc6d-42c1-b8f1-ceb0539176d5-upicture2.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/031259b9-bc6d-42c1-b8f1-ceb0539176d5-upicture2.png}{\includegraphics{images/031259b9-bc6d-42c1-b8f1-ceb0539176d5-upicture2.png}}{}
\makeatother 
\caption{\boldmath {Age Classification}}
\label{f-d3139f61f190}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/d2c62bb6-7785-44f1-9f5e-80591aba53af-upicture3.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/d2c62bb6-7785-44f1-9f5e-80591aba53af-upicture3.png}{\includegraphics{images/d2c62bb6-7785-44f1-9f5e-80591aba53af-upicture3.png}}{}
\makeatother 
\caption{\boldmath {Type of Surgery}}
\label{f-d37836b4854c}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/688a8a29-349a-4d1f-a1e9-7fe43f24496c-upicture4.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/688a8a29-349a-4d1f-a1e9-7fe43f24496c-upicture4.png}{\includegraphics{images/688a8a29-349a-4d1f-a1e9-7fe43f24496c-upicture4.png}}{}
\makeatother 
\caption{\boldmath {Type of Procedure}}
\label{f-901dbe61804f}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/474a3d7c-1ca8-4a7b-a739-0fa33adc3dfd-upicture5.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/474a3d7c-1ca8-4a7b-a739-0fa33adc3dfd-upicture5.png}{\includegraphics{images/474a3d7c-1ca8-4a7b-a739-0fa33adc3dfd-upicture5.png}}{}
\makeatother 
\caption{\boldmath {Type of Co-Morbidities}}
\label{f-22c464e40201}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/8a60d9f2-c3cb-4a0f-96cc-bc88d0b32bdc-upicture6.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/8a60d9f2-c3cb-4a0f-96cc-bc88d0b32bdc-upicture6.png}{\includegraphics{images/8a60d9f2-c3cb-4a0f-96cc-bc88d0b32bdc-upicture6.png}}{}
\makeatother 
\caption{\boldmath {Antimicrobials Prescribed as Preoperative and Postoperative Prophylactic Agents}}
\label{f-a330b7075c24}
\end{figure}
\egroup

\begin{table*}[!htbp]
\caption{\boldmath {Wound Classification} }
\label{tw-bb1ddee52b0a}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3819\linewidth-2\tabcolsep}p{\dimexpr.27810000000000002\linewidth-2\tabcolsep}p{\dimexpr.34\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Type of Wound & \cAlignHack Frequency (N) & \cAlignHack Percentage (\%)\\
\tblmidrule 
\cAlignHack Clean &
  \cAlignHack 82 &
  \cAlignHack 36.1\%\\
\cAlignHack Clean contaminated &
  \cAlignHack 109 &
  \cAlignHack 48\%\\
\cAlignHack Contaminated &
  \cAlignHack 36 &
  \cAlignHack 15.9\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Co-Morbid Conditions} }
\label{tw-387fbb53b6c2}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.38190000000000005\linewidth-2\tabcolsep}p{\dimexpr.27809999999999995\linewidth-2\tabcolsep}p{\dimexpr.34\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Co-Morbid Condition & \cAlignHack Frequency (N) & \cAlignHack Percentage (\%)\\
\tblmidrule 
\cAlignHack Yes &
  \cAlignHack 10 &
  \cAlignHack 4.4\%\\
\cAlignHack No &
  \cAlignHack 217 &
  \cAlignHack 95.6\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Indication of Surgical Antibiotic Prophylaxis (SAP)} }
\label{tw-518251e0dcdb}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.7013\linewidth-2\tabcolsep}p{\dimexpr.14749999999999998\linewidth-2\tabcolsep}p{\dimexpr.15119999999999997\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Variables & \cAlignHack Frequency & \cAlignHack Percentage\\
\tblmidrule 
Antimicrobial prophylaxis is recommended and given. &
  \cAlignHack 143 &
  \cAlignHack 62.99\%\\
Antimicrobial prophylaxis is not recommended or used. &
  \cAlignHack 31 &
  \cAlignHack 13.65\%\\
Antimicrobial prophylaxis was recommended but not used. &
  \cAlignHack 8 &
  \cAlignHack 3.5\%\\
Antimicrobial prophylaxis is not recommended, yet it is given anyhow. &
  \cAlignHack 45 &
  \cAlignHack 19.8\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Duration of Postoperative Prophylaxis} }
\label{tw-7136c4e33c1f}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3247\linewidth-2\tabcolsep}p{\dimexpr.2458\linewidth-2\tabcolsep}p{\dimexpr.21890000000000004\linewidth-2\tabcolsep}p{\dimexpr.2106\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Duration of Postoperative Prophylaxis & \cAlignHack Yes & \cAlignHack No & \cAlignHack P-Value\\
\tblmidrule 
\cAlignHack \ensuremath{\geq }24 hrs &
  \cAlignHack 38 (84.4\%) &
  \cAlignHack 7 (15.6\%) &
  \multicolumn{1}{p{\dimexpr(.2106\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{\cAlignHack 0.02}}\\
\cAlignHack \textless\ 24 hrs &
  \cAlignHack 68 (62.4\%) &
  \cAlignHack 4 (37.6\%) &
  \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
\textbf{Antimicrobial Prophylaxis Use Compared to Guideline Recommendations}

Only 143 (94.7\%) of patients for whom SAP was advised got prophylaxis, whereas 31 (40.8\%) of those who had no indication did not get prophylaxis. As a result, 174 (78.4\%) individuals had SAP indications that were suitable. 110 (76.9\%) of the patients for whom SAP was prescribed and delivered got precise dosages. Nearly all (95.8\%) of the patients for whom prophylaxis was indicated and administered were given broad-spectrum antibiotics or unnecessary combinations, while 6 (4.2\%) were given antimicrobial agents that were insufficient to cover the bacteria most likely to be encountered at the specific surgical site. None of the antibiotics on the list were suitable for the surgical procedures. In all cases, the timing of administration of the first preoperative dosage was unknown. 76 individuals (66.7 percent) of patients who got postoperative prophylaxis received it within 24 hours of surgery. The most prevalent deviation from guideline guidelines was the use of antibacterial drugs (100 percent), followed by the length of postoperative prophylaxis (33.3 percent).

\textbf{Compliance}

Compliance to all of the indicated criteria was 0\% among the 143 (63\%) patients who had prophylactic indications and received prophylaxis. In contrast, 31 (13.7\%) of patients had no indication and were not given prophylaxis. As a result, 13.7 percent of the population followed the ASHP guidelines.

In clinical settings, the fundamental responsibility of the clinical pharmacist is to evaluate and update existing antibiotic guidelines. This study's findings may be useful to physicians in improving patient care. It is also highly useful for healthcare decision-makers to lower the incidence of surgical site infection as a function of treatment costs and to understand the pattern of antibiotic sensitivity in hospitals. Antibiotic prophylaxis, which consists of a short course of antibiotics given soon before the commencement of surgical operations in clean, clean-contaminated, and unclean conditions, is advised to minimize postoperative infection. Primary prophylaxis, secondary prophylaxis, and eradication are all terms used to describe the prevention of infection. The prevention of first infection is referred to as primary prophylaxis. The prevention of recurrence or reactivation of a pre-existing infection is referred to as secondary prophylaxis. The term "eradication" refers to the removal of a colonized organism in order to prevent the spread of infection.
    
\section{CONCLUSION}
Between SAP practice and guideline guidelines, there was a lot of discrepancy. The most flagrant violation of the criteria was the incorrect selection of antimicrobial drugs. The prevalence of SSI was high, necessitating immediate care. The kind of operation, wound classification, and length of postoperative prophylaxis has all been identified as risk factors for SSI. Postoperative prophylaxis should be limited to fewer than 24 hours. Patients with clean wounds, like those with contaminated wounds, require constant monitoring to limit the risk of SSI. It is suggested that studies aimed at isolating the common bacterium responsible for SSI be conducted. Surgical antibiotic prophylaxis guidelines were still not being followed to the letter. To lower the risk of surgical site infection, it is required to make some measures to increase compliance with surgical antibiotic prophylactic recommendations. To address the problem of non-compliance with antibiotic prophylaxis recommendations, local hospital standards for surgical antibiotic prophylaxis should be developed by adopting national or worldwide guidelines. A complex educational strategy comprising a collaborative effort of healthcare providers can have a considerable impact on antibiotic efficacy and surgical site infection prevention. Local guidelines appear to be more likely to be accepted and followed than national guidelines.
    
\section{Acknowledgement}
The authors are grateful to the hospital personnel for providing supporting documents and granting us access to medical records charts. We are also appreciative of the collaboration of our employees and sponsors.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that there is no conflict of interest.
    
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