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Introduction: Surgical site infections account for 14%-25% of all nosocomial infections. The main aims of this study were to audit the use of prophylactic antibiotic, to quantify the rate of post-operative wound infection, and to identify risk factors for its occurrence in general surgery. Methodology: A cross-sectional study was conducted in the General Surgery Department in Khartoum Teaching Hospital– Sudan. All Adult patients (age >18 years) admitted during March 1st to 31st October 2010 were recruited. Multivariable logistic analysis was done to identify wound infection risk factors. Prescriptions were audited against predetermined criteria. Results: A total of 540 patients were recruited; (females73.7% of total ). The performed surgical procedures were 547. The rate of wound infection was 10.9%. Multivariable logistic analysis showed that; ASA score > 3; (p= <0.001), wound class (p= 0.001), and laparoscopic surgical technique; (p= 0.002) were significantly associated with prevalence of wound infection. Surgical prophylaxis was unnecessarily given to 311 (97.5%) of 319 patients for whom it was not recommended. Prophylaxis was recommended for 221 patients; of them 218 (98.6 %) were given preoperative dose in the operating rooms. Evaluation of prescriptions for those patients showed that; spectrum of antibiotic was adequate for 160 (73.4%) patients, 143 (65.6%) were given accurate doses, only 4 (1.8%) had the first preoperative dose/s in proper time window, and for 186 (85.3%) of them prophylaxis was extended post-operatively. Only 36 (6.7%) prescriptions were found to be complying with the stated criteria. Conclusion: The rate of wound infection was high and prophylactic antibiotics were irrationally used. Multiple interventions are needed to correct the situation. [ABSTRACT FROM AUTHOR]

Objective: To ascertain that antibiotics have no role in the management of bronchiolitis. Design: Multicentre randomized control trial (RCT). Setting: Five purposively selected teaching hospitals in Bangladesh. Patient: Children under 24 months old with bronchiolitis. Interventions: Children were randomized into three groups of therapeutic interventions: parenteral ampicillin (P-Ab), oral erythromycin (O-Ab) and no antibiotic (N-Ab) in adjunct to supportive measures. Main outcome measures: Clinical improvement was assessed using 18 symptoms/signs which were graded on a two-point recovery scale of ‘rapid’ and ‘gradual’, indicating improvement within ‘four days’ and ‘beyond four days’, respectively. Results: Each intervention group consisted of 98 ± 1 children having comparable clinico-epidemiological characteristics at the baseline. The trial revealed that most chesty features (features appearing to arise from chest, i.e. cough, breathing difficulty, wheeze, chest indrawing, tachypnoea, tachycardia, rhonchi and crepitation) demonstrated a gradual recovery, beyond 4th admission day and, not differing among the three intervention groups (p > 0.23, p < 0.62, p = 0.54, p < 0.27, p = 0.75, p = 0.76, p = 0.81, p > 0.98, respectively). Most non-chesty features (features appearing to arise away from chest, i.e. feeding/sleeping difficulties, social smile, restlessness, inconsolable crying, nasal flaring, fever and hypoxaemia) demonstrated a rapid recovery, within 4 days, remaining comparable among the three intervention groups (p < 0.07, p = 0.65, p = 0.24, p < 0.61, p = 0.22, p = 0.84, p = 0.29 and p = 0.96, respectively). However, nasal symptoms (runny nose and nasal blockage) also showed no difference among groups (p = 0.36 and p = 0.66, respectively). Thus, the dynamics of clinical outcome obviates that children not receiving antibiotics had similar clinical outcome than those who did. Conclusion: In hospital settings, managing bronchiolitis with only supportive measures but without antibiotics remains preferable. [ABSTRACT FROM AUTHOR]