A Comparative Study of No Antibiotic versus Single Dose Prophylactic Antibiotics in Clean and Clean Contaminated Surgical Cases

Abstract

Background: Surgical site infections remain a significant cause of postoperative morbidity, increasing hospital stay and healthcare costs. Although antibiotic prophylaxis has improved surgical outcomes, its overuse contributes to antimicrobial resistance and adverse effects. The necessity of prophylactic antibiotics in clean and clean-contaminated surgeries remains controversial. This study evaluates the role of single-dose prophylactic antibiotics compared to no antibiotic use in preventing SSI (Surgical Site Infections).

Methods: This randomized prospective study was conducted on 100 patients undergoing clean and clean-contaminated surgeries between December 2017 and April 2019. Patients were divided into two groups: Group A (n=50) received a single preoperative dose of third-generation cephalosporin, and Group B (n=50) received no antibiotics. Wounds were assessed for SSI on postoperative days 2, 5, and 7 using Southampton scoring. Statistical analysis was performed using chi-square and t-tests with significance set at p<0.05.

Results: Out of 100 patients, 17% developed SSI. In Group A, 18% (9 patients) developed SSI, while in Group B, 16% (8 patients) developed SSI. No statistically significant association was found between antibiotic use and SSI occurrence (p=0.590). SSI rates were 14% in clean cases and 20% in clean-contaminated cases. Risk factors such as prolonged preoperative hospital stay, advanced age, smoking, diabetes, and drain placement contributed to higher SSI incidence. No significant association was observed with sex, BMI, or smoking individually. Conversion from no-antibiotic to full antibiotic therapy occurred in 6% of cases.

Conclusion: Single-dose prophylactic antibiotics did not significantly reduce SSI compared to no antibiotic use in clean and clean-contaminated surgeries. SSI occurrence is more strongly associated with patient-related and procedural risk factors rather than antibiotic prophylaxis alone. Rational antibiotic use, improved surgical techniques, and risk factor management are essential to minimize SSI and prevent antibiotic resistance.