Patterns of antibiotic use in orthopaedic surgery at the Kenyatta National Hospital

Abstract

Purpose The purpose of this study was to assess the patterns of antibiotic use in treatment of surgical site infections at the Kenyatta National Hospital orthopaedic wards. Methodology This was a cross sectional study involving orthopaedic surgery patients who met the inclusion criteria.Data was collected using a questionnaire and an observation schedule. In this study, only 40 patients met the inclusion criteria. The relevant information was extracted from these patients by a number of structured questiones. This information was then harmonized by consulting the patients' files and treatment sheets. Results It was found that the most common classes of antibiotics used in the treatment of surgical site infections in the orthopaedic wards were penicillins, cephalosporins and metronidazole. Intravenous administration was much more common than oral administration. Out ofthe 40 patients, 26 patients (65%) were on either double or triple antibiotic combination therapy while 35% were on monotherapy. Metronidazole appeared in more than 95% of the combination therapies. These were empiric therapies designed to cover both gram positive, gram negative and anaerobic bacteria. Conclusion Although vancomycin and cephazolin (a cephalosporin) are considered to be the gold standard antibiotics for the treatment of bone infection, KNH practice deviates from these guidelines. Instead the main antibiotics used are flucloxacillin, cefuroxime, ceftriaxone, metronidazole and gentamicin. The reason for this deviation was not conclusively established. Treatment of surgical site infections is empiric and culture and sensitivity tests are rarely done.