title: Benefit of a single preoperative dose of antibiotics in a sub-saharan district hospital: minimal input, massive impact.
abstract: OBJECTIVE
  To evaluate the impact of a single-shot preoperative antimicrobial prophylaxis (AMP) to reduce the rate of Surgical Site Infections (SSIs) in a rural sub-Saharan hospital.
  
  
  BACKGROUND
  We analyzed the incidence of SSIs in a rural Tanzanian hospital with very limited resources and found that AMP was administered after incision in 88% without covering the expected pathogens. Inadequacy and mistiming of AMP proved to be major risk factors for SSI in this study. Subsequently, 21.6% of patients developed an SSI after clean or clean-contaminated surgery, with 60% of detected pathogens being resistant to the administered antibiotics. In developed countries, preoperative single shot AMP is widely used and effective in the prevention of SSI.
  
  
  METHODS
  Implementation and monitoring of guidelines for routine and adequate single shot AMP within 2 hours prior to incision in every clean and clean-contaminated intervention.
  
  
  RESULTS
  In the preintervention group, 527 patients qualified for routine AMP that was administered in 88% of patients after incision and did not cover the expected pathogens to a large extent.114 patients (21.6%) developed an SSI, with 60% of detected pathogens being resistant to the administered antibiotics. After implementation of the guidelines, the incidence of SSIs significantly decreased from 21.6% to 4% (11/276).
  
  
  CONCLUSIONS
  The implementation of a single shot AMP dramatically decreased the rate of SSI in a hospital with very limited resources. Such guidelines, developed by industrialized countries, are even more effective in non-industrialized countries.
authors.affiliation: Department of Medicine and Diagnostics, Swiss Tropical Institute Basel, Switzerland.
authors.forename: Franziska
authors.initials: F
authors.lastname: Saxer
authors.forename: Andreas
authors.initials: A
authors.lastname: Widmer
authors.forename: Jan
authors.initials: J
authors.lastname: Fehr
authors.forename: Isaac
authors.initials: I
authors.lastname: Soka
authors.forename: Pascience
authors.initials: P
authors.lastname: Kibatala
authors.forename: Honorathy
authors.initials: H
authors.lastname: Urassa
authors.forename: Reno
authors.initials: R
authors.lastname: Frei
authors.forename: Thomas
authors.initials: T
authors.lastname: Smith
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012424:Rural Population; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013636:Tanzania; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents