Attitudes of Nigerian Orthopedic Surgeons Toward Peri-operative Antibiotic Practices: A 2024 Perspective
Authors
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Background and Aim: Surgical site infections (SSIs) remain a major complication in orthopedic surgery, contributing to morbidity, prolonged hospitalization, and economic burden. This study explores the attitudes of Nigerian orthopedic surgeons toward peri-operative antibiotic practices. Material and Methods: A descriptive cross-sectional survey was conducted among 34 orthopedic surgeons in Nigeria, including consultants and senior registrars across public and private hospitals. Data were collected via a structured, self-administered online questionnaire covering socio-demographics, antibiotic practices, and attitudes toward stewardship. Responses were analyzed using SPSS v27, with descriptive statistics applied. Results: Respondents had a mean age of 44.3 years (SD 8.1); most were male (86.9 %) and worked in teaching hospitals (41.7 %). Cephalosporins were the most prescribed prophylactic agents (63.1 %), with combination therapy more common (59.5 %). Timing was split between intra-operative (58.3 %) and pre-operative (41.7 %) administration. SSI rates were estimated as <1 % by 47.6 % of respondents, though 75.0 % reported no departmental audits. Willingness to engage in quality improvement was high (95.2 %), yet only 27.4 % were open to alternative regimens. Research evidence (36.5 %) and patient-specific factors (29.2 %) were the main drivers for potential change. Conclusion: Nigerian orthopedic surgeons demonstrate reliance on personal experience and broad-spectrum antibiotic use, with limited audit practices and partial alignment with global guidelines. High willingness to improve suggests that evidence-based, locally contextualized stewardship interventions could optimize peri-operative antibiotic use and reduce SSI risk.
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2025 Ifeanyi C. Agwulonu, Hakeem Badmus, Chinonye Osuala, Oluyemisi Okwudishu
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Ifeanyi C. Agwulonu, Department of Surgery, Orthopedic and Traumatology unit, Babcock University Teaching Hospital, Ilishan Remo, Nigeria.
Department of Surgery, Orthopedic and Traumatology unit, Babcock University Teaching Hospital, Ilishan Remo, Nigeria.
Hakeem Badmus, Department of Orthopedic and Traumatology, Hospital for Trauma and Surgery, Lekki, Nigeria.
Department of Orthopedic and Traumatology, Hospital for Trauma and Surgery, Lekki, Nigeria.
Chinonye Osuala, Department of Orthopedic and Trauma, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
Department of Orthopedic and Trauma, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
Oluyemisi Okwudishu, Department of Internal Medicine, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
Department of Internal Medicine, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
[1] Troughton R, Mariano V, Campbell A, Hettiaratchy S, Holmes A, Birgand G. Understanding determinants of infection control practices in surgery: the role of shared ownership and team hierarchy. Antimicrob Resist Infect Control. 2019 Jul 15;8:116.
[2] Costabella F, Patel KB, Adepoju AV, Singh P, Attia Hussein Mahmoud H, Zafar A, Patel T, Watekar NA, Mallesh N, Fawad M, Sathyarajan DT, Abbas K. Healthcare Cost and Outcomes Associated With Surgical Site Infection and Patient Outcomes in Low- and Middle-Income Countries. Cureus. 2023 Jul 26;15(7):e42493.
[3] Hou Y, Collinsworth A, Hasa F, Griffin L. Incidence and impact of surgical site infections on length of stay and cost of care for patients undergoing open procedures. Surg Open Sci. 2022 Nov 8;11:1-18. doi: 10.1016/j.sopen.2022.10.004. Erratum in: Surg Open Sci. 2023 Oct 12;16:134-135.
[4] Dhole S, Mahakalkar C, Kshirsagar S, Bhargava A. Antibiotic Prophylaxis in Surgery: Current Insights and Future Directions for Surgical Site Infection Prevention. Cureus. 2023 Oct 28;15(10):e47858.
[5] Hassan S, Chan V, Stevens J, Stupans I. Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review. Syst Rev. 2021 Jan 16;10(1):29.
[6] Lundine KM, Nelson S, Buckley R, Putnis S, Duffy PJ. Adherence to perioperative antibiotic prophylaxis among orthopedic trauma patients. Can J Surg. 2010 Dec;53(6):367-72.
[7] Owens, R. C., & Stoessel, K. Surgical site infections: Epidemiology, microbiology and prevention. Journal of Antimicrobial Chemotherapy. 2008. 61(suppl_2), ii3-ii20.
[8] Ozgun H, Ertugrul BM, Soyder A, Ozturk B, Aydemir M. Peri-operative antibiotic prophylaxis: adherence to guidelines and effects of educational intervention. Int J Surg. 2010;8(2):159-63. doi: 10.1016/j.ijsu.2009.12.005. Epub 2009 Dec 16.
[9] Muteeb G, Rehman MT, Shahwan M, Aatif M. Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals (Basel). 2023 Nov 15;16(11):1615.
[10] Foxlee ND, Townell N, Heney C, McIver L, Lau CL. Strategies Used for Implementing and Promoting Adherence to Antibiotic Guidelines in Low- and Lower-Middle-Income Countries: A Systematic Review. Trop Med Infect Dis. 2021 Sep 13;6(3):166.
[11] Segala, F.V., Murri, R., Taddei, E. et al. Antibiotic appropriateness and adherence to local guidelines in perioperative prophylaxis: results from an antimicrobial stewardship intervention. Antimicrob Resist Infect Control 9, 164 (2020). https://doi.org/10.1186/s13756-020-00814.
[12] Okeke IN, Laxminarayan R, Bhutta ZA, Duse AG, Jenkins P, O'Brien TF, Pablos-Mendez A, Klugman KP. Antimicrobial resistance in developing countries. Part I: recent trends and current status. Lancet Infect Dis. 2005 Aug;5(8):481-93.
[13] Santoshi JA, Behera P, Nagar M, Sen R, Chatterjee A. Current Surgical Antibiotic Prophylaxis Practices: A Survey of Orthopaedic Surgeons in India. Indian J Orthop. 2020 Nov 18;55(3):749-757. doi: 10.1007/s43465-020-00306-0.
[14] Lohiniva AL, Heweidy I, Girgis S, Abouelata O, Ackley C, Samir S, Talaat M. Developing a theory-based behavior change intervention to improve the prescription of surgical prophylaxis. Int J Clin Pharm. 2022 Feb;44(1):227-234. doi: 10.1007/s11096-021-01338-8. Epub 2021 Nov 20. Erratum in: Int J Clin Pharm. 2022 Feb;44(1):300.
[15] Gunaratnam C, Bernstein M. Factors Affecting Surgical Decision-making-A Qualitative Study. Rambam Maimonides Med J. 2018 Jan 29;9(1):e0003.
[16] Oyedeji R, Abimbola S. How tertiary hospitals can strengthen primary health care in Nigeria. Niger Med J. 2014 Nov;55(6):519-20.
[17] Donkor ES, Osman AH, Aglomasa BC, Awere-Duodu A, Odoom A, Opoku-Asare B, Lazarus G. Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis. Antimicrob Resist Infect Control. 2025 Feb 3;14(1):5.
[18] Olowo-Okere A, Ibrahim YKE, Sani AS, Olayinka BO. Occurrence of Surgical Site Infections at a Tertiary Healthcare Facility in Abuja, Nigeria: A Prospective Observational Study. Med Sci (Basel). 2018 Jul 30;6(3):60
[19] Ikeanyi UO, Chukwuka CN, Chukwuanukwu TO. Risk factors for surgical site infections following clean orthopaedic operations. Niger J Clin Pract. 2013 Oct-Dec;16(4):443-7.
[20] Iheanacho CO, Eze UIH. Antimicrobial resistance in Nigeria: challenges and charting the way forward. Eur J Hosp Pharm. 2022 Mar;29(2):119.
[21] Amaraegbulam, P. Orthopaedic subspecialisation: The Nigerian experience. Nigerian Journal of Orthopaedics and Trauma. 2018. 17, 8-11.
[22] Imediegwu, K., Igwe, O., Onyebuchukwu, C., Okonkwo, K., Ngwu, A., Nduka, A., Okeke, K., Anya, J., Onyesoro, C., Akunna, J., & Oladiran, A. Factors Affecting Choice of Subspecialisation amongst Orthopaedic Surgery Residents in Southern Nigeria. Journal of the West African College of Surgeons. 2024. 15, 27-30.
[23] Madubueze, C. C., Umaru, H., & Alada, A. A. Attitudes of Nigerian orthopaedic surgeons to the use of prophylactic antibiotics. International Orthopaedics. 2015. 39(11), 2161-2165.
[24] Mwita JC, Ogunleye OO, Olalekan A, Kalungia AC, Kurdi A, Saleem Z, Sneddon J, Godman B. Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications. Int J Gen Med. 2021 Feb 18;14:515-530
[25] Yang Z, Meng H, Li J, Du P, Lv H, Zhao K, Zhang J, Li M, Jin Z, Peng Z, Ye D, Ding K, Song Z, Wang J, Xing X, Zhu Y, Zhang Y, Chen W. Association between the generation of cephalosporins for perioperative prophylaxis and postoperative surgical site infections in open fractures: a prospective cohort study. Int J Surg. 2025 Jun 1;111(6):3810-3820.
[26] Ahmed, N. J., Haseeb, A., Alamer, A., Almalki, Z. S., Alahmari, A. K., & Khan, A. H. Meta-Analysis of Clinical Trials Comparing Cefazolin to Cefuroxime, Ceftriaxone, and Cefamandole for Surgical Site Infection Prevention. Antibiotics. 2022. 11(11), 1543.
[27] Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy. Mayo Clin Proc. 2011 Feb;86(2):156-67.
[28] Alabi ED, Rabiu AG, Adesoji AT. A review of antimicrobial resistance challenges in Nigeria: The need for a one health approach. One Health. 2025 Apr 27;20:101053
[29] Alsaeed OM, Bukhari AA, Alshehri AA, Alsumairi FA, Alnami AM, Elsheikh HA. The Use of Antibiotics for the Prevention of Surgical Site Infections in Two Government Hospitals in Taif, Saudi Arabia: A Retrospective Study. Cureus. 2022 Jul 11;14(7):e26731.
[30] Weber, W. P., Mujagic, E., Zwahlen, M., Bundi, M., Hoffmann, H., Soysal, S. D., Kraljević, M., Delko, T., von Strauss, M., Iselin, L., Sousa Da Silva, R. X., Zeindler, J., Rosenthal, R., Misteli, H., Kindler, C., Müller, P., Saccilotto, R., Kopp Lugli, A., Kaufmann, M., & Gürke, L. Timing of surgical antimicrobial prophylaxis: A phase 3 randomised controlled trial. The Lancet Infectious Diseases. 2017; 17(6), 605-614.
[31] Legesse, T., Hiko, D., Ismael, E. K., & Abdella, S. H. Evaluation of surgical antimicrobial prophylaxis use in Ethiopia: Prospective study. African Journal of Pharmacy and Pharmacology. 2018; 12(31), 455-463.
[32] Afriyie DK, Amponsah SK, Dogbey J, Agyekum K, Kesse S, Truter I, Meyer JC, Godman B. A pilot study evaluating the prescribing of ceftriaxone in hospitals in Ghana: findings and implications. Hosp Pract (1995). 2017 Oct;45(4):143-149
[33] Upadhyyaya GK, Tewari S. Enhancing Surgical Outcomes: A Critical Review of Antibiotic Prophylaxis in Orthopedic Surgery. Cureus. 2023 Oct 27;15(10):e47828.
[34] Allegranzi, B., Bagheri Nejad, S., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., & Pittet, D. Burden of endemic health-care–associated infection in developing countries: systematic review and meta-analysis. The Lancet. 2011; 377(9761), 228-241.
[35] Dohmen, P. M. (2006). Antibiotic resistance in common pathogens reinforces the need to minimize surgical site infections. Journal of Hospital Infection, 63, S25–S29.
[36] Carrard, V., Mast, S., Jaunin-Stalder, N., Perron, J., & Sommer, J. Patient-Centeredness as Physician Behavioral Adaptability to Patient Preferences. Health Communication. 2018; 33, 593 - 600.
[37] Grad, R., Sandhu, A., Ferrante, M., D’Souza, V., Puterman-Salzman, L., Abbasgholizadeh Rahimi, S., Stevens, G., & Elwyn, G. Using incorpoRATE to examine clinician willingness to engage in shared decision making: A study of Family Medicine residents. Patient Education and Counseling. 2022 105(12), 3529-3533.