Effects of an antimicrobial stewardship intervention on perioperative antibiotic prophylaxis in pediatrics

Abstract

PurposeThis study aims to determine the effectiveness of an Antimicrobial Stewardship Program based on a Clinical Pathway (CP) to improve appropriateness in perioperative antibiotic prophylaxis (PAP).Materials and methodsThis pre-post quasi-experimental study was conducted in a 12 month period (six months before and six months after CP implementation), in a tertiary Pediatric Surgical Centre. All patients from 1 month to 15 years of age receiving one or more surgical procedures were eligible for inclusion. PAP was defined appropriate according to clinical practice guidelines.ResultsSeven hundred sixty-six children were included in the study, 394 in pre-intervention and 372 in post-intervention. After CP implementation, there was an increase in appropriate PAP administration, as well as in the selection of the appropriate antibiotic for prophylaxis, both for monotherapy (p = 0.02) and combination therapy (p = 0.004). Even the duration of prophylaxis decreased during the post-intervention period, with an increase of correct PAP discontinuation from 45.1 to 66.7% (p < 0.001). Despite the greater use of narrow-spectrum antibiotic for fewer days, there was no increase in treatment failures (10/394 (2.5%) pre vs 7/372 (1.9%) post, p = 0.54).ConclusionsCPs can be a useful tool to improve the choice of antibiotic and the duration of PAP in pediatric patients.

Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery

“…Our previously published article on CP's impact on PAP guideline adherence confirmed other research findings with a significantly increased rate in narrow-spectrum antibiotic usage [8].…”

“…For a detailed description of the CPs, complete with pocket card images, see the previous study [8].…”

“…Most of the studies investigating ASPs for PAP are targeted to the adult population, with only few focusing on children and limited data on the efficacy and safety of these strategies [4][5][6][7]. For this reason, our study group conducted a first study in 2016-2017 with the aim of determining the effectiveness of an ASP based on a clinical pathway (CP) to improve the adherence to PAP guidelines in our Pediatric Surgery Unit [8]. The results showed a positive impact of the intervention, which was followed by an increase in appropriate PAP administration and in the selection of the appropriate antibiotic for prophylaxis, with a reduction in use of combination therapies and broad-spectrum antibiotics.…”

Evaluation of Pediatric Surgical Site Infections Associated with Colorectal Surgeries at an Academic Children’s Hospital

“…Donà et al noted variability in antibiotic prescribing for AP in their single-center study that evaluated the use of AP in children undergoing surgical procedures. The authors found that in the pre-intervention group, antibiotic selection was inappropriate in 51% of cases, and antibiotics were continued for a prolonged duration in 54.9% of cases [23]. Implementation of a clinical pathway proved to be a useful tool and led to a statistically significant improvement in the selection and duration of AP in pediatric patients; however, there still remained room for improvement of AP compliance in the post-intervention group [23].…”

“…The authors found that in the pre-intervention group, antibiotic selection was inappropriate in 51% of cases, and antibiotics were continued for a prolonged duration in 54.9% of cases [23]. Implementation of a clinical pathway proved to be a useful tool and led to a statistically significant improvement in the selection and duration of AP in pediatric patients; however, there still remained room for improvement of AP compliance in the post-intervention group [23]. Sandora et al evaluated the national appropriateness of AP in children undergoing common surgical procedures using the Pediatric Health Information System database, and they noted significant variation in the use of AP across the 31 institutions submitting data [24].…”