Surgical Antimicrobial Prophylaxis for the Prevention of Surgical Site Infections: A Prospective Cohort Study Should We Follow the Guidelines?

Background: Surgical antimicrobial prophylaxis (SAP) is a cornerstone for reducing surgical site infections (SSIs), yet its implementation remains inconsistent. This study evaluates the impact of adherence to local SAP guidelines (GDSAP) versus surgeon-directed practices (SDSAP) on SSI outcomes. Methodology: A prospective cohort of 827 surgical patients in two Jordanian hospitals was evaluated. After filtering for eligibility and outcome availability, 464 patients were analysed—232 in each group (GDSAP vs. SDSAP). SSI by day 90 was the primary outcome. Data were collected through patient monitoring, medical records, and post-discharge surveillance. Missing data (Results: Groups were demographically and clinically balanced. Post-discharge antibiotic use was higher in SDSAP (75%) compared to GDSAP (59%) (P Conclusion: Adherence to SAP guidelines has significantly reduced SSI rates and reflects a decrease in post-discharge antimicrobial overuse. Hospitals should implement tailored SAP protocols and multidisciplinary stewardship to ensure safer surgical outcomes.