The Incidence of Surgical Site Infection and the Implementation of Prophylactic Antibiotic Use in General Surgery Patients
DOI:
https://doi.org/10.54518/rh.6.2.2026.1082Keywords:
Antibiotic Appropriateness, Clean and Clean-Contaminated Surgery, Prophylactic Antibiotics, Surgical Site InfectionAbstract
Surgical Site Infection (SSI) occurs within 30 days after surgery or 90 days with an implant. Prophylactic antibiotics prevent SSI by reducing bacterial contamination, but misuse can increase infection risk and antibiotic resistance. This study aims to assess the incidence of SSI, types of surgery (clean or clean-contaminated), indications, and appropriateness of prophylactic antibiotics, and adherence to clinical guidelines. A retrospective observational design was used, analyzing secondary data at the General Surgery Clinic from March to June 2025. Adult patients (≥18 years) who received prophylactic antibiotics were included. Findings showed most patients were male, aged 18–25 and 46–55 years. Cefazolin was the most commonly used antibiotic (82.76%), followed by ceftriaxone (17.24%), primarily administered intravenously within 30 minutes before incision. Prophylactic antibiotic use was appropriate in 82.76% of cases, though timing adherence was low (35.63%). SSI incidence was 2.3%, occurring in both clean and clean-contaminated surgeries, with cases linked to ceftriaxone misuse. The study highlights the importance of stricter adherence to prophylactic antibiotic protocols, particularly regarding timing, to further reduce SSI risk.
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Adzillina, E., Sundari, S., & Ijabah, S. M. (2024). Evaluation of Administration Prophylactic Antibiotic against Incidence of Surgical Site Infection in Post Appendectomy at Panembahan Senopati Hospital, Indonesia. JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit), 13(1), 1-15.
Aghdassi, S. J. S., Schröder, C., & Gastmeier, P. (2019). Gender-related risk factors for surgical site infections. Results from 10 years of surveillance in Germany. Antimicrobial Resistance & Infection Control, 8(1), 95-106.
Akresh, A. B., Alzeet, D. S., Alshalan, N. Z., Alhawsawi, M. M., Alsaleh, N. A., Binsuwaidan, R. A., ... & Alnajjar, L. I. (2025). The impact of antibiotic prophylaxis appropriateness, duration and associated cost on the rate of surgical site infection at a tertiary hospital in Riyadh, Saudi Arabia: A retrospective study. Saudi Medical Journal, 46(6), 65-76.
Alamrew, K., Tadesse, T. A., Abiye, A. A., & Shibeshi, W. (2019). Surgical antimicrobial prophylaxis and incidence of surgical site infections at Ethiopian tertiary-care teaching hospital. Infectious Diseases: Research and Treatment, 12(1), 117-129.
Alexandra, O. (2015). Pencegahan infeksi dalam pelayanan keluarga berencana (Manual rujukan berdasarkan pemecahan masalah). Jakarta: PKMI.
Allegranzi, B., Bischoff, P., De Jonge, S., Kubilay, N. Z., Zayed, B., Gomes, S. M., ... & Solomkin, J. S. (2016). New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. The Lancet Infectious Diseases, 16(12), 276-287.
Alsen, M., & Sihombing, R. (2014). Infeksi luka operasi. Majalah Kedokteran Sriwijaya, 46(3), 229-235.
Amelia, K., & Komar, H. (2019). Kajian pola penggunaan antibiotik profilaksis hubunganya dengan angka kejadian infeksi daerah operasi (IDO) pada pasien bedah digestif. Jurnal Sains Farmasi & Klinis, 6(3), 186-190.
Amirah, A., Harahap, J., Willim, H. A., Suroyo, R. B., & Henderson, A. H. (2024). Effect of comorbidities on the incidence of surgical site infection in patients undergoing emergency surgery: a systematic review and meta-analysis. Journal of Clinical Medicine Research, 16(7-8), 345-355.
Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., Nyquist, A.-C., Saiman, L., Yokoe, D. S., Maragakis, L. L., & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(2), S66–S88.
Awoke, N., Arba, A., & Girma, A. (2019). Magnitude of surgical site infection and its associated factors among patients who underwent a surgical procedure at Wolaita Sodo University Teaching and Referral Hospital, South Ethiopia. Plos One, 14(12), 226-240.
Berríos-Torres, S. I., Umscheid, C. A., Bratzler, D. W., Leas, B., Stone, E. C., Kelz, R. R., Reinke, C. E., Morgan, S., Solomkin, J. S., Mazuski, J. E., Dellinger, E. P., Itani, K. M. F., Berbari, E. F., Segreti, J., Parvizi, J., Blanchard, J., Allen, G., Kluytmans, J. A. J. W., Donlan, R., & for the Healthcare Infection Control Practices Advisory Committee. (2017). Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surgery, 152(8), 784-799.
Bhat, R. A., Isaac, N. V., Joy, J., Chandran, D., Jacob, K. J., & Lobo, S. (2024). The effect of American Society of Anesthesiologists score and operative time on surgical site infection rates in major abdominal surgeries. Cureus, 16(2), 9(5), 76-88.
Boonchan, T., Wilasrusmee, C., McEvoy, M., Attia, J., & Thakkinstian, A. (2017). Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery. British Journal of Surgery, 104(2), 106–117.
Bratzler, D. W. (2005). Use of antimicrobial prophylaxis for major surgery: Baseline results from the National Surgical Infection Prevention Project. Archives of Surgery, 140(2), 174-186.
Bratzler, D. W., & Houck, P. M. (2005a). Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. The American Journal of Surgery, 189(4), 395–404.
Bratzler, D. W., & Houck, P. M. (2005b). Reply to Chenoweth et al. Clinical Infectious Diseases, 41(1), 123–124.
Bratzler, D. W., & Hunt, D. R. (2006). Healthcare epidemiology: The surgical infection prevention and surgical care improvement projects: National initiatives to improve outcomes for patients having surgery. Clinical Infectious Diseases, 43(3), 322–330.
Bratzler, D. W., Dellinger, E. P., Olsen, K. M., Perl, T. M., Auwaerter, P. G., Bolon, M. K., Fish, D. N., Napolitano, L. M., Sawyer, R. G., Slain, D., Steinberg, J. P., & Weinstein, R. A. (2013). Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy, 70(3), 195–283.
Caesarridha, D. K., Wintoko, R., Mustofa, S., & Soleha, T. U. (2024). Hubungan usia, jenis kelamin, dan jarak jahitan luka dengan kejadian infeksi luka operasi pada pasien apendisitis perforasi di RSUD Dr. H. Abdul Moeloek Provinsi Lampung tahun 2020-2021. Medical Profession Journal of Lampung, 14(5), 971–978.
Chairani, F., Puspitasari, I., & Asdie, R. H. (2019). Insidensi dan faktor risiko infeksi luka operasi pada bedah obstetri dan ginekologi di rumah sakit. Jurnal Manajemen Dan Pelayanan Farmasi (Journal of Management and Pharmacy Practice), 9(4), 274–283.
Cheng, H., Chen, B. P.-H., Soleas, I. M., Ferko, N. C., Cameron, C. G., & Hinoul, P. (2017). Prolonged operative duration increases risk of surgical site infections: A systematic review. Surgical Infections, 18(6), 722–735.
Dalbøge, A., Frost, P., Andersen, J. H., & Svendsen, S. W. (2017). Surgery for subacromial impingement syndrome in relation to occupational exposures, lifestyle factors and diabetes mellitus: A nationwide nested case–control study. Occupational and Environmental Medicine, 74(10), 728–736.
De Jonge, S. W., Gans, S. L., Atema, J. J., Solomkin, J. S., Dellinger, P. E., & Boermeester, M. A. (2017). Timing of preoperative antibiotic prophylaxis in 54,552 patients and the risk of surgical site infection: A systematic review and meta-analysis. Medicine, 96(29), 69-83.
Dhole, S., Mahakalkar, C., Kshirsagar, S., & Bhargava, A. (2023). Antibiotic prophylaxis in surgery: Current insights and future directions for surgical site infection prevention. Cureus, 15(10), 931-945.
Dianat, I., Bazazan, A., Souraki Azad, M. A., & Salimi, S. S. (2018). Work-related physical, psychosocial and individual factors associated with musculoskeletal symptoms among surgeons: Implications for ergonomic interventions. Applied Ergonomics, 67(10), 115–124.
Du, Y., Han, S., Zhou, Y., Chen, H. F., Lu, Y. L., Kong, Z. Y., & Li, W. P. (2023). Severe wound infection by MRCNS following bilateral inguinal herniorrhaphy. BMC Infectious Diseases, 23(1), 85-99.
Gallagher, J. C., & MacDougall, C. (2023). Antibiotics simplified (5th ed.). London: Jones & Bartlett Learning.
Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., ... & Ljungqvist, O. (2019). Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018. World Journal of Surgery, 43(3), 659-695.
Haryanto, E. (2024). Hubungan penyakit penyerta dengan terjadinya infeksi luka operasi pada pasien di ruang bedah dan syaraf RSD Kalisat. Jember: Universitas dr. Soebandi (Doctoral dissertation)
Hendrawan, F., Nugrahningsih, D. A. A., Purnomo, E., & Azdy, N. A. (2024). Risk factor for inappropriate use of prophylactic antibiotics in inguinal hernia repair surgery. The Medical Journal of Malaysia, 79(4), 58-62.
Horan, T. C., Andrus, M., & Dudeck, M. A. (2008). CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control, 36(5), 309–332.
Horasan, E. S., Dağ, A., Ersoz, G., & Kaya, A. (2013). Surgical site infections and mortality in elderly patients. Médecine et Maladies Infectieuses, 43(10), 417–422.
Huda, F., Shasheendran, S., Basu, S., Kumar, N., Rajput, D., Singh, S. K., David, L. E., & Subramanian, C. (2022). Risk factors of surgical site infection in elective laparotomy in a tertiary care center: An observational study. International Journal of Burns and Trauma, 12(3), 106–113.
Iwatani, T., & Saito, S. (2023). Surgical site infections in thyroid and parathyroid surgery in Japan: An analysis of the Japan Nosocomial Infections Surveillance database from 2013 to 2020. International Wound Journal, 20(6), 1874–1881.
Jahangir, F., Haghdoost, A., Moameri, H., & Okhovati, M. (2024). Incidence and risk factors of surgical site infection in abdominal surgeries: A scoping review of cohort and case-control studies. Iranian Journal of Medical Sciences, 49(7), 402-412.
Kamel, C., McGahan, L., Mierzwinski-Urban, M., & Embil, J. (2013). Preoperative skin antiseptic preparations and application techniques for preventing surgical site infections: A systematic review of the clinical evidence and guidelines. Canada: Canadian Agency for Drugs and Technologies in Health.
Karaali, C., Emiroğlu, M., Çalık, B., Kebapci, E., Kaya, T., Budak, G. G., ... & Sert, I. (2019). Evaluation of antibiotic prophylaxis and discharge prescriptions in the general surgery department. Cureus, 11(6), 33-43.
Lee, H., Kim, M.-J., Lee, I.-K., Hong, C.-W., & Jeon, J.-H. (2024). Impact of hyperglycemia on immune cell function: A comprehensive review. Diabetology International, 15(4), 745–760.
Lubis, A., Wintoko, R., Ismunandar, H., & Windarti, I. (2024). Surgical site infection. Medical Profession Journal of Lampung, 14(2), 213–217.
Lumbantobing, R., Maulia, S. H., & Novelyn, S. (2022). Overview of evaluation of prophylactic antibiotics in patients with hernia cases at a private hospital in South Tangerang, Indonesia, during the period January 2019–December 2020. Journal of Complementary and Alternative Medical Research, 19(4), 31-42.
Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., Jarvis, W. R., & The Hospital Infection Control Practices Advisory Committee. (1999). Guideline for prevention of surgical site infection, 1999. Infection Control & Hospital Epidemiology, 20(4), 247–280.
Marni, H., Djanas, D., & Bachtiar, H. (2020). Pengaruh pemberian antibiotik profilaksis sefazolin, seftriakson dan antibiotik seftriakson sebelum dan sesudah operasi terhadap infeksi luka pasca operasi. Andalas Obstetrics and Gynecology Journal, 7(4), 77–86.
Masriadi, H., & Km, S. (2017). Epidemiologi penyakit menular. Surabaya: PT. RajaGrafindo Persada-Rajawali Pers.
Mayhew, D., Mendonca, V., & Murthy, B. V. S. (2019). A review of ASA physical status – historical perspectives and modern developments. Anaesthesia, 74(3), 373–379.
Menz, B. D., Charani, E., Gordon, D. L., Leather, A. J., Moonesinghe, S. R., & Phillips, C. J. (2021). Surgical antibiotic prophylaxis in an era of antibiotic resistance: Common resistant bacteria and wider considerations for practice. Infection and Drug Resistance, 14(7), 235–5252.
Meyer, A. C., Eklund, H., Hedström, M., & Modig, K. (2021). The ASA score predicts infections, cardiovascular complications, and hospital readmissions after hip fracture—A nationwide cohort study. Osteoporosis International, 32(11), 2185–2192.
Misganaw, D., Linger, B., & Abesha, A. (2020). Surgical antibiotic prophylaxis use and surgical site infection pattern in Dessie Referral Hospital, Dessie, Northeast of Ethiopia. BioMed Research International, 2020(1), 169-183.
Muhammad, S. D., Faisal, M. S., Shafiq, M. A., & Saeed, M. R. (2023). Incidence of surgical site infection following open hernioplasty and comparison of infection rate among ventral and groin hernia repairs at a THQ hospital Lahore: A single surgeon experience. JPMA: The Journal of the Pakistan Medical Association, 73(6), 1241–1244.
Murdiana, H. E. (2022). Evaluasi penggunaan profilaksis antibiotik bedah umum di rumah sakit pemerintah di Yogyakarta. Health Sciences and Pharmacy Journal, 6(1), 1–9.
Nirbita, A., Rosa, E. M., & Listiowati, E. (2017). Faktor risiko kejadian infeksi daerah operasi pada bedah digestif di rumah sakit swasta. Jurnal Fakultas Kesehatan Masyarakat, 11(2), 93–98.
Odah, A., Alhusban, H., Kaff, A. A., Alkhawaldeh, F., Alwraikat, S., & Alshoufeen, S. (2023). Proper timing for administration of prophylactic intravenous antibiotics for elective surgical procedures. SAS Journal of Surgery, 9(4), 309–314.
Olsen, M. A., Nickel, K. B., Fox, I. K., Margenthaler, J. A., Ball, K. E., Mines, D., Wallace, A. E., & Fraser, V. J. (2015). Incidence of surgical site infection following mastectomy with and without immediate reconstruction using private insurer claims data. Infection Control & Hospital Epidemiology, 36(8), 907–914.
Palubicka, A., Jaworski, R., Wekwejt, M., Swieczko-Zurek, B., Pikula, M., Jaskiewicz, J., & Zielinski, J. (2019). Surgical site infection after breast surgery: A retrospective analysis of 5-year postoperative data from a single center in Poland. Medicina, 55(9), 512-524.
Pradipta, I., Sodik, D., Parwati, I., Lestari, K., Halimah, E., Diantini, A., & Abdulah, R. (2013). Antibiotic resistance in sepsis patients: Evaluation and recommendation of antibiotic use. North American Journal of Medical Sciences, 5(6), 344-357.
Pratama, N. Y., Suprapti, B., Ardhiansyah, A. O., & Shinta, D. W. (2019). Analisis penggunaan antibiotik pada pasien rawat inap bedah dengan menggunakan defined daily dose dan drug utilization 90% di Rumah Sakit Universitas Airlangga. Indonesian Journal of Clinical Pharmacy, 8(4), 256-278.
Rohana, Q., Amrullah, A. W., Rahardjoputro, R., & Widyastuti, E. Z. (2024). Analisis rasionalitas penggunaan antibiotik profilaksis pada pasien bedah di Rumah Sakit X Surakarta. JIKES: Jurnal Ilmu Kesehatan, 3(1), 81–89.
Rusli, S. R., Juhamran, R. P., Jafar, M. A., Gani, A. B., & Hasbi, B. E. (2025). Hubungan antara infeksi daerah operasi (IDO) dan faktor risiko pada pasien pasca operasi di rumah sakit pancaitana kabupaten bone tahun 2023. Jurnal Ilmiah Manusia dan Kesehatan, 8(1), 227-240.
Russ, A., & Kennedy, G. D. (2016). Postoperative complications. In The ASCRS Textbook of Colon and Rectal Surgery (pp. 121-140). Cham: Springer International Publishing.
Sartelli, M., Guirao, X., Hardcastle, T. C., Kluger, Y., Boermeester, M. A., Raşa, K., ... & Catena, F. (2018). 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World Journal of Emergency Surgery, 13(1), 58-68.
Siswandi, A., Wulandari, M., Erianto, M., & Mawaddah Noviska, A. (2020). Hubungan status gizi dengan proses penyembuhan luka pada pasien post apendektomi. ARTERI: Jurnal Ilmu Kesehatan, 1(3), 226–232.
Soper, D. E., & Chelmow, D. (2018). Prevention of infection after gynecologic procedures. Obstetrics and Gynecology, 131(6), E172-E189.
Stefanou, A., Worden, A., Kandagatla, P., Reickert, C., & Rubinfeld, I. (2020). Surgical wound misclassification to clean from clean-contaminated in common abdominal operations. Journal of Surgical Research, 246(6), 131–138.
Tigora, A., Radu, P. A., Garofil, D. N., Bratucu, M. N., Zurzu, M., Paic, V., ... & Ramboiu, S. (2025). Modern perspectives on inguinal hernia repair: a narrative review on surgical techniques, mesh selection and fixation strategies. Journal of Clinical Medicine, 14(14), 48-65.
Tjandra, J., Clunie, G. J., Kaye, A. H., & Smith, J. A. (Eds.). (2008). Textbook of surgery. London: John Wiley & Sons.
Tjitrawati, A. T., & Romadhona, M. K. (2024). Living beyond borders: The international legal framework to protecting rights to health of Indonesian illegal migrant workers in Malaysia. International Journal of Migration, Health and Social Care, 20(2), 227-45.
Tjitrawati, A. T., Tavip, M., & Romadhona, M. K. (2023). Integrative social-health security for Indonesian migrant workers: Does fully covered and protected? Malaysian Journal of Medicine and Health Sciences, 19(12), 67–78.
Uruno, T., Masaki, C., Suzuki, A., Ohkuwa, K., Shibuya, H., Kitagawa, W., Nagahama, M., Sugino, K., & Ito, K. (2015). Antimicrobial prophylaxis for the prevention of surgical site infection after thyroid and parathyroid surgery: A prospective randomized trial. World Journal of Surgery, 39(5), 1282–1287.
Vierra, M., Rouhani Ravari, M., Soleymani Sardoo, F., & Shogan, B. D. (2024). Tailored pre-operative antibiotic prophylaxis to prevent post-operative surgical site infections in general surgery. Antibiotics, 13(1), 99-110.
Wahyudi, I., Kinasih, S. E., Ida, R., Koesbardiati, T., Romadhona, M. K., & Kim, S. (2024). Biosecurity infectious diseases of the returning Indonesian migrant workers. Global Security: Health, Science and Policy, 9(1), 238-247.
WHO. (2016). Global guidelines for the prevention of surgical site infection. Retrieved on August, 20, 2025 from https://iris.who.int/bitstream/handle/10665/250680/9789241549882 eng.pdf?sequence=1.
Wilson, J., Woods, I., Fawcett, J., Whall, R., Dibb, W., Morris, C., & McManus, E. (1999). Reducing the risk of major elective surgery: Randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ, 318(71), 1099–1103.
Witsø, E. (2012). The role of infection-associated risk factors in prosthetic surgery. HIP International, 22(8), 5–8.
Xu, Z., Qu, H., Gong, Z., Kanani, G., Zhang, F., Ren, Y., Shao, S., Chen, X., & Chen, X. (2021). Risk factors for surgical site infection in patients undergoing colorectal surgery: A meta-analysis of observational studies. Plos One, 16(10), 259-274.
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