Antimicrobial Prophylaxis in Elective Orthopaedic Surgical Procedures at the Tertiary Care Hospital: A Prospective Observational Study

<b>Objective:</b> Surgical antimicrobial prophylaxis (SAP) is vital for preventing surgical site infections (SSIs). This study evaluated adherence to local SAP guidelines and assessed SSI-related risk factors in elective orthopaedic surgeries. <b>Methods:</b> A prospective observational study was conducted at a tertiary care hospital between August and October 2023. Patients were categorised into two groups: those receiving guideline-adherent SAP (SAP group) and those with inadequate SAP (ISAP group), defined by incorrect dosing or prolonged duration. Various patient- and procedure-related SSI risk factors were compared between groups. <b>Results:</b> Among 82 patients, 81 received SAP, but only a small proportion received it correctly. Most deviations were due to extended duration and incorrect dosing, resulting in 90.20% non-adherence. Despite this, no significant differences in known SSI risk factors were observed between the two groups, and no SSIs were reported during the study period. <b>Conclusions:</b> Non-adherence to SAP guidelines was widespread, mainly due to extended prophylaxis. Importantly, non-adherence was not associated with increased SSI risk, nor was it linked to higher baseline patient risk factors, suggesting that decisions were influenced more by clinical routine than by patient-specific risk. These findings emphasize the need to strengthen staff education and adherence to guidelines, thereby supporting antimicrobial stewardship in resource-limited settings.