Therapeutic and Clinical Outcome Evaluation Cefazoline as a

Prophylactic Antibiotics in the Central Operating Room in a National

Hospital West Jakarta Period October – December 2022

Yudith Mamenoh Makawaehe

and Diana Laila Rahmatillah

Undergraduate Study Program Universitas 17 Agustus 1945 Jakarta, Indonesia

Faculty of Pharmacy at Universitas 17 Agustus 1945 Jakarta, Indonesia

Keywords: Cefazoline, Clean Contaminated Surgery, Clinical Outcome.

Abstract: Prophylactic antibiotics are commonly used to prevent and treat surgical site infections. Cefazolin is a

commonly used prophylactic antibiotic due to its effectiveness in various surgical procedures. The objective

of this study was to evaluate the therapeutic and clinical outcomes of clean-contaminated surgical patients at

West Jakarta National Hospital. The research was conducted retrospectively using an observational cohort

that met the inclusion criteria during the period of October-December 2022. The clinical outcome factors were

analysed using the chi-square test of SPSS. The study included 106 patients who met the inclusion criteria.

Most patients (43.5%) were aged between 46-60 years and female (60.4%), had a normal BMI (52.9%), were

non-smokers (89.6%), non-drinkers (84.9%), had no comorbidities (84.9%), and had no family history of the

disease (82.1%). Approximately 93.4% of patients were hospitalized for 10 days or less. 98.1% of the patients

had a positive clinical outcome, while 1.9% experienced a decrease. Statistical analysis revealed that the

length of treatment (p=0.001) significantly affected the clinical outcome. On the other hand, patients'

sociodemographic factors did not have a significant impact on the clinical outcome.

1 INTRODUCTION

Surgery is a medical procedure that involves invasive

techniques, such as incisions, to access and treat

internal body parts. Proper handling and closure of

the surgical wound is crucial to prevent microbial

infections in the patient. In Southeast Asia, surgical

wound infections have a high incidence rate of 7.8%,

second only to nosocomial infections. Antibiotics can

be used to treat infections in surgical wounds.

Prophylactic antibiotics, such as cefazolin, can be

administered to patients to prevent surgical wound

infections. It is well-tolerated when administered

intramuscularly or intravenously. Cefazolin is the

preferred antibiotic for surgical prophylaxis due to its

broad-spectrum activity, favorable pharmacokinetic

profile, low incidence of side effects, and relatively

low cost. Additionally, cefazolin exhibits activity

against certain Enterobacter species. Cefazoline has a

half-life of approximately 2 hours. Compared to other

first-generation cephalosporins, such as cefalexin,

cephalothin, cefapirin, and cefadroxil, cefazoline has

the advantage of being more lipophilic, which allows

for better penetration into bone. Therefore, cefazolin is

recommended as an antibiotic in surgery.

Antibiotic therapy is commonly used to evaluate

the appropriateness of antibiotics in patients. The

'right drug, right dose, right indication, right patient'

tool is widely used to assess the quality of antibiotic

use in various countries. Clinical outcomes are the

results experienced by patients after receiving

treatment and are a key determinant of therapy

success. The US Food and Drug Administration states

that clinical outcome assessments evaluate

symptoms, mental condition, and the impact of

disease on patient activity. These assessments can

determine whether drugs provide benefits or not.

The aim of this study is to investigate the factors

associated with clinical outcomes of clean

contaminated surgical patients. Specifically, the

study evaluates the therapeutic and clinical outcomes

of using cefazolin as a prophylactic antibiotic in the

central surgical room at West Jakarta National

Hospital during the period of October to December

2022.

Makawaehe, Y. and Rahmatillah, D.

Therapeutic and Clinical Outcome Evaluation Cefazoline as a Prophylactic Antibiotics in the Central Operating Room in a National Hospital West Jakarta Period October – December 2022.

DOI: 10.5220/0012641700003821

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 4th International Seminar and Call for Paper (ISCP UTA ’45 JAKARTA 2023), pages 187-190

ISBN: 978-989-758-691-0; ISSN: 2828-853X

187

2 METHODS

This research was conducted retrospectively using a

cohort design. The data was obtained from primary

sources in the form of medical records of patients who

received clean-contaminated surgical therapy at West

Jakarta National Hospital between October and

December 2022.

The collected data includes the patient's diagnosis,

age, sex, BMI, smoking, and alcohol consumption

status, personal and family medical history, length of

treatment, cefazolin dosage, antibiotics administered

post-surgery, and clinical outcome. The data was

collected from the time of the patient's admission for

cancer diagnosis and treatment until their discharge

or death.

3 RESULTS & DISCUSSIONS

Table 1: Sociodemographic of Cleanly Contaminated

Surgical Patients (n=106).

The study's results were obtained from the medical

records (RM) of 106 patients diagnosed with cancer

who received clean contaminated surgical therapy at

the West Jakarta National Hospital between October

and December 2022.

Table 1 shows the distribution of age categories

among the patients. The age groups are 18-30 years

(7 patients, 6.6%), 31-45 years (33 patients, 31.1%),

46-60 years (46 patients, 43.5%), 61-75 years (19

patients, 17.9%), and ≥ 76 years (1 patient, 0.9%).

Many patients belonged to the 46-60 years age group,

which had 46 patients. Out of the total number of

patients, 60.4% were women and 39.6% were men.

The BMI variable was divided into three categories:

underweight (20.7%), healthy weight (52.9%), and

overweight (26.4%). Most of the patients (52.9%)

were in the healthy weight category. Within the

smoker variable, 95 patients (89.6%) did not smoke,

while 11 patients (10.4%) were smokers. Concerning

the alcohol drinking variables, 90 patients (84.9%)

did not consume alcohol, while 16 patients (15.1%)

were alcohol drinkers. Out of the total number of

patients, 84.9% (90 individuals) had no history of the

disease, while the remaining 15.1% (16 individuals)

had a history of the disease. In terms of family history,

82.1% (87 individuals) did not have a family history

of the disease, while the remaining 17.9% (19

individuals) had a family history of the disease. Of the

patients, 99 (93.4%) received treatment for 10 days or

less, while 7 (6.6%) received treatment for more than

10 days.

Figure 1: Shows the distribution of dosage conformity in

the field with guideline n=106.

Based on Figure 1, the data shows that 98.1% of

clean surgical cancer patients who received

cefazoline therapy at West Jakarta National Hospital

ISCP UTA ’45 JAKARTA 2023 - THE INTERNATIONAL SEMINAR AND CALL FOR PAPER (ISCP) UTA ’45 JAKARTA

188

were compliant with the existing guidelines, which

was 104 patients. The remaining 1.9% of patients had

dose discrepancies with the existing guidelines, with

appropriate and inappropriate ratios of 52:1. There is

a discrepancy in dosage due to the rescheduling of

surgical elective patients who were previously

allocated to the operating room.

According to the regulation of the Ministry of

Health (Peraturan Menteri Kesehatan) No. 28 of

2021, chapter IV, page 29, recommends the use of

prophylactic antibiotics for surgery. The first choice

is generally a systemic cephalosporin from the first

generation, such as 2 grams of cefazolin. for patients

weighing over 120 kg, a dose of 3 grams of cefazolin

was administered.

3.1 Statistical Analysis of Relationship

Factors Influencing Clinical

Outcomes of Cleanly Contaminated

Surgical Patients

Table 2: Relationships Affecting Clinical Outcomes.

Table 2 shows that the length of treatment (p=0.001)

is the significant factor affecting clinical outcome.

Raths et al. identified several factors that influence

the length of patient treatment, including the type and

severity of the disease, age, secondary diagnosis, and

medical action. Sociodemographic factors, including

age, gender, BMI, smoking, alcohol consumption,

personal medical history, and family medical history,

have no significant relationship with the clinical

outcomes of clean-contaminated surgical patients.

Figure 2: Number of Clinical Outcomes with Cefazoline

Therapy.

Figure 2 shows that during the period of October

to December 2022, the majority of surgical cancer

patients who received cefazoline therapy at West

Jakarta National Hospital were contaminated. Out of

106 patients, 104 (98.1%) were cured, while the

remaining 2 (1.9%) died. The ratio of cured to dead

patients was 52:1. Patients who experience negative

clinical outcomes do not necessarily die because of

antibiotic use. Instead, they may be affected by

decreased body resistance, sepsis, or neutropenia.

4 CONCLUSION AND ADVICE

The study analyzed data from 106 patients. Most

patients were female (60.4%) and aged between 46-

60 years (43.3%). The average BMI was 22.827

kg/m2. Most patients were non-smokers (89.6%) and

non-drinkers (84.9%). Additionally, 84.9% had no

history of disease, and 82.1% had no family history

of disease. The average length of treatment was 4.87

days. The statistical analysis indicates that there is no

Therapeutic and Clinical Outcome Evaluation Cefazoline as a Prophylactic Antibiotics in the Central Operating Room in a National

Hospital West Jakarta Period October – December 2022

189

sociodemographic relationship with clinical

outcomes. However, the length of treatment (p=

0.001) is a significant factor affecting clinical

outcomes.

The treatment administered to surgically treated

cancer patients who were contaminated with

cefazolin therapy at the West Jakarta National

Hospital mostly adhered to the dosage guidelines

outlined in Regulation of Ministry of Health /

Peraturan Menteri Kesehatan (PMK) No. 28 of 2021,

Chapter IV, page 29.

During the period of October to December 2022,

at West Jakarta National Hospital, surgical cancer

patients who were contaminated and received

cefazoline therapy mostly had positive clinical

outcomes (98.1%). It is important to note that patients

who did not have positive clinical outcomes were not

affected by antibiotics, but rather by decreased body

resistance, sepsis, or neutropenia.

The researcher suggests that similar studies

should be conducted prospectively at the West Jakarta

National Hospital for comparison purposes based on

the study results.

ACKNOWLEDGMENT

The author expresses gratitude to all parties who

contributed to the completion of this research.

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