Vol. 12, Issue 2 (2026)

Background: Appropriate perioperative antibiotic prophylaxis is a key preventive strategy against surgical site infections (SSIs) in orthopedic surgery. Despite well-established recommendations, deviations from guideline-based practices are frequently observed, particularly in resource-constrained settings. This study aimed to evaluate compliance with recommended antibiotic prophylaxis practices in orthopedic surgeries and analyze their association with post-operative clinical outcomes.

Methods: A prospective observational study was conducted in Department of Orthopedics at Shree bhausaheb hire government medical college, Dhule. Adult patients undergoing orthopedic surgical procedures were enrolled over a 9-month period. Antibiotic prophylaxis practices were assessed for compliance with standard guideline principles, including antibiotic selection, timing, and duration. Patients were followed for 30 days (non-implant surgeries) and 90 days (implant surgeries). Surgical site infection rates and other outcomes were compared between compliant and non-compliant groups.

Results: A total of 248 orthopedic surgical procedures were analyzed. Overall compliance with antibiotic prophylaxis guidelines was observed in 152 cases (61.3%). Surgical site infection

occurred in 3.3% of compliant cases compared to 11.5% of non-compliant cases (p = 0.01).

Prolonged post-operative antibiotic administration beyond 24 hours was the most common deviation. On multivariate analysis, non-compliance with antibiotic prophylaxis guidelines (adjusted OR 3.92), diabetes mellitus, and prolonged duration of surgery were independently associated with increased SSI risk.

Conclusion: Non-compliance with recommended antibiotic prophylaxis practices is common in orthopedic surgery and is associated with significantly higher rates of surgical site infection. Improving adherence to evidence-based protocols represents a feasible and high-impact intervention to enhance surgical outcomes and promote antimicrobial stewardship.