National assessment of the prescribing practice and quality of surgical antibiotic prophylaxis (SAP) in obstetrics and gynaecological surgery in Kuwait : mixed method research

Alshatti, Fahad

Thesis

National assessment of the prescribing practice and quality of surgical antibiotic prophylaxis (SAP) in obstetrics and gynaecological surgery in Kuwait : mixed method research

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Creator

Alshatti, Fahad

Rights statement

Strathclyde Thesis Copyright

Awarding institution

University of Strathclyde

Date of award

2026

Thesis identifier

T18086

Person Identifier (Local)

202160667

Qualification Level

Doctoral (Postgraduate)

Qualification Name

Doctor of Philosophy (PhD)

Department, School or Faculty

Strathclyde Institute of Pharmacy and Biomedical Sciences

Abstract

Inappropriate surgical antibiotic prophylaxis (SAP) contributes to avoidable adverse events, antimicrobial resistance and unnecessary costs. Despite the importance of SAP in obstetrics and gynaecological (OB/GYN) surgery, Kuwait has lacked national evidence to guide SAP practice. This thesis aimed to assess the SAP prescribing practices across Kuwait and explore behavioural and system-level factors influencing the practice with an ultimate goal of improving the quality of SAP prescribing through tailored antimicrobial stewardship interventions to the Kuwait healthcare system. A sequential mixed-method approach was used. First, a national point prevalence survey (PPS) was conducted across nine hospitals to assess SAP practice including compliance against local and international guidelines. The survey showed poor compliance level, extensive broad-spectrum antibiotic use, incorrect SAP timing, prolonged postoperative antibiotic use and poor documentation. The second stage involved a national Knowledge, Attitude, and Practice (KAP) survey of prescribers, which showed low overall knowledge, common misconceptions and beliefs and wide variation in self-reported practice. The final qualitative study used Capability, Opportunity, Motivation-Behaviour (COM-B)-guided interviews to explore behavioural and organisational factors, which revealed gaps in training, strong influence from patient and seniors, defensive prescribing and limited guideline accessibility. Collectively, this thesis provided the first national assessment of SAP in OB/GYN surgery in Kuwait and identified potential AMS interventions tailored to the local context. Notably, despite Kuwait being a high-income country, the prescribing practices were found to be more comparable in quality to those reported in low-income settings, highlighting the need for tailored stewardship regardless of resource level.

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