Adherence to surgical antibiotic prophylaxis guidelines in children: A cohort study

Abstract

Aims: Surgical antimicrobial prophylaxis (SAP) is an important measure to reduce post-operative infections. Guidelines exist, but their efficacy and performance in children is poorly understood compared with adults. To review adherence to SAP guidelines, this study assesses risk factors for non-adherence and rate of early post-surgical infections. Methods: A retrospective cohort study of paediatric surgical cases (0-<18 years) at a tertiary children's hospital was performed. Patient characteristics, surgical factors and antimicrobial details were evaluated against hospital guidelines for overall adherence and domains of: antimicrobial choice, dose, re-dosing, timing and duration. Multiple regression analysis was used to determine risk factors for non-adherence. Hospital records were reviewed for post-operative infections at 7 and 30 days. Results: Among 326 cases, overall guideline adherence was 39.6% but varied by domain and surgical subspecialty. Incorrect wound classification was associated with overall non-adherence on multivariate regression (odds ratio (OR): 2.59; P < 0.001). Incorrect antimicrobial choice was more likely in children with penicillin hypersensitivity (OR 138.34, P = 0.004) and incorrect dosing more likely in adolescent patients (OR 4.33; P = 0.004). Presence of invasive devices was associated with prolonged duration of antimicrobials (OR 2.92, P = 0.016). Only two post-operative infections were documented by 30 days, but data were insufficient to exclude mild infections managed in the community. Conclusions: SAP was suboptimal in children, with areas for improvement including better guidance on wound classification, allergy management and care for adolescent patients. Documented infections were rare, but mild infections were unable to be excluded due to limited postdischarge information.

Preoperative Antibiotic Prophylaxis in Elective Minor Surgical Procedures among Adults in Southern Italy

“…The antibiotic choice was not in accordance with national [ 24 ] and international guidelines [ 8 , 25 , 26 , 27 ] in almost one out of five of the procedures. This finding is in line with data presented in the literature [ 12 , 16 , 18 , 28 , 29 ]. Choosing an appropriate antibiotic is a critical issue in the correct implementation of SAP.…”

“…Despite several studies focused on antibiotic prescribing habits in conjunction with surgeries in different countries having been recently published [ 16 , 17 , 18 ], little is known regarding the factors associated with SAP compliance in elective minor surgery [ 19 , 20 , 21 ]. Consequently, it is imperative to acquire such information.…”

Adherence to Perioperative Antibiotic Prophylaxis Recommendations and Its Impact on Postoperative Surgical Site Infections

“…To our knowledge, this is the first study to evaluate the impact of adherence to ACS recommendations for surgical antimicrobial prophylaxis (including timing, dosing, and redosing) and the development of SSI in pediatric patients. Mohamed Rizvi et al reported low adherence to guidelines for antimicrobial surgical prophylaxis in pediatric patients (39.6%) but did not evaluate the association between adherence and the development of SSI [ 16 ]. Bardia et al found poor adherence to guidelines (overall 35.9%, 19.7% for antibiotic choice, 17.1% for weight-adjusted dosing, 0.6% for timing of the first dose, and 26.8% for redosing) [ 17 ].…”

Surgical Antibiotic Prophylaxis in an Era of Antibiotic Resistance: Common Resistant Bacteria and Wider Considerations for Practice

“…19,111 Despite these considerations, many studies have demonstrated that even when such protocols and guidelines exist, they are often poorly adhered to. [112][113][114][115][116][117][118][119][120] Studies investigating the implementation of AMS programs in the surgical setting have shown improved guideline adherence in several studies. [121][122][123] Segala et al found that prior to the implementation of stewardship programs, antimicrobial prophylaxis was either not required, or appropriate but not given, occured 41% of the time and that 29% of the cases were prescribed for longer than indicated.…”