Darren K. Dookeeram

Background: Antibiotic prophylaxis is a critical intervention in reducing postoperative infections, yet inappropriate prescribing remains a global contributor to antimicrobial resistance (AMR). Trinidad and Tobago lacks localized data on perioperative antibiotic practices, hindering effective antimicrobial stewardship. The aim of this paper was to assess the prescribing patterns, appropriateness, and outcomes of prophylactic antibiotic use across various surgical departments at the Sangre Grande Hospital, a secondary care hospital in eastern Trinidad. Methods: A retrospective observational study was conducted on 235 randomly selected patient records from January 2024 to April 2025. Data included demographics, surgical category, type and route of antibiotics administered, duration of hospital stay, and use of microbiological testing. Antibiotics were classified using the WHO AWaRe framework. Results: Among the 235 patients, n=124 52.8% were female and n=111, 47.2% were male. General surgery accounted for the majority of procedures n=175 (74.5%). Antibiotic prophylaxis was administered in n= 225, 85.1% of cases. The majority n=140, 62.2% were from the WHO “Access” category and n=85, 37.8% from the “Watch” category. Augmentin n=100 (44.4%), Ceftriaxone n=57 (25.3%), and Metronidazole n=39 (17.3%) were the most frequently used antibiotics. Most antibiotics were delivered intravenously 155 (66%). Only four patients (1.7%) had microbiological cultures sent, despite the availability of susceptibility testing. The surgical site infection (SSI) rate was low (0.44%), and n=102, 45.5% of patients were discharged within one day post-surgery. Conclusion: This study reveals widespread empirical antibiotic use with low reliance on culture-based prescribing. Despite a low SSI rate, the underutilization of microbiological testing and the reliance on “Watch” category antibiotics present stewardship concerns. This article bridges antibiotic stewardship with infection prevention and control and emphasizes the utility of combining the two disciplines.

SETTING A GLOBAL STAGE The Latin America and the Caribbean (LAC) region encompasses a broad geographic expanse of states whose sociopolitical and economic systems have evolved over time as reflections of a variable colonial past, power imbalances with more advanced nation-states, and intra-regional cultural identity struggles. The varying extent of these “centre-periphery” internal and external […]

An antimicrobial consumption (AMC) study was performed in Trinidad and Tobago at the Eastern Regional Health Authority (ERHA). A retrospective, cross-sectional survey was conducted from 1 November 2021 to 30 March 2022. Dosage and package types of amoxicillin, azithromycin, co-amoxiclav, cefuroxime, ciprofloxacin, levofloxacin, moxifloxacin, nitrofurantoin and co-trimoxazole were investigated. Consumption was measured using the World Health Organization’s Antimicrobial Resistance and Consumption Surveillance System methodology version 1.0, as defined daily doses (DDD) per 1000 population per day (DID). They were also analyzed using the ‘Access’, ‘Watch’ and ‘Reserve’ classifications. In the ERHA, AMC ranged from 6.9 DID to 4.6 DID. With regards to intravenous formulations, the ‘Watch’ group displayed increased consumption, from 0.160 DID in 2017 to 0.238 DID in 2019, followed by a subsequent drop in consumption with the onset of the COVID-19 pandemic. Oral co-amoxiclav, oral cefuroxime, oral azithromycin and oral co-trimoxazole were the most highly consumed antibiotics. The hospital started off as the higher consumer of antibiotics, but this changed to the community. The consumption of ‘Watch’ group antibiotics increased from 2017 to 2021, with a drop in consumption of ‘Access’ antibiotics and at the onset of COVID-19. Consumption of oral azithromycin was higher in 2021 than 2020.