Inappropriate prophylactic use of antibiotics in gynecologic surgeries in an inner city hospital

As antibiotic resistance is an increasing healthcare issue, promotion of antibiotic stewardship within hospitals has led to research into their proper use. The American College of Obstetricians and Gynecologists (ACOG) has specific recommendations for antimicrobial prophylaxis prior to gynecologic procedures. We hypothesized that patients in an inner-city hospital in Oklahoma City, Oklahoma undergoing gynecologic procedures were receiving prophylactic antibiotics that were not necessarily indicated for their surgery. A retrospective chart review was performed from July, 2017 to June, 2018. 314 surgeries were performed in this time and 169 cases met inclusion criteria as gynecologic procedures with no indication for antimicrobial prophylaxis. Of the 169 included cases, 98 (57.99%) revealed antibiotics were inappropriately given, which was statistically significant (p <0.5). The most common procedure in which misuse was noted were laparoscopic procedures without entry into the bowel or vagina, composing 61.2% of cases. Cefazolin was the most frequently used and was given in 84.7% of the cases. These results reflect the overuse of antibiotics for surgical prophylaxis, which contributes to increasing antibiotic resistance in women undergoing elective gynecologic procedures. Overall, this is hindering the progressive movement towards promotion of antibiotic stewardship. We hope that these study results will limit the misuse of antibiotics in a hospital setting, and specifically in surgical specialties.