Implementing a Standardized Perioperative Antibiotic Prophylaxis Protocol for Neonates Undergoing Cardiac Surgery

Abstract

Background A lack of perioperative antibiotic prophylaxis guidelines for neonates undergoing cardiac surgery has resulted in a wide variation in practice. We sought to: 1) determine the safety of a perioperative antibiotic prophylaxis protocol for neonatal cardiac surgery as measured by surgical site infections (SSIs) rates before and after implementation of the protocol and 2) evaluate compliance with selected process measures for perioperative antibiotic prophylaxis. Methods This quasi-experimental study included all cardiac procedures performed on neonates from July 2009 to June 2012 at a single center. An interdisciplinary task force developed a standardized perioperative antibiotic prophylaxis protocol in the fourth quarter of 2010. SSI rates were compared in the pre-intervention (July 2009 to December 2010) versus the post-intervention periods (January 2011 to June 2012). Compliance with process measures (appropriate drug, dose, timing, and discontinuation of perioperative antibiotic prophylaxis) was compared in the two periods. Results During the study period, 283 cardiac procedures were performed. SSI rates were similar in the pre- and post-intervention periods (6.21 vs. 5.80 per 100 procedures respectively). Compliance with the four process measures significantly improved post-intervention. Conclusions Restricting the duration of perioperative antibiotic prophylaxis after neonatal cardiac surgery to 48 hours in neonates with a closed sternum and to 24 hours after sternal closure was safe and did not increase the rate of SSIs. Compliance with selected process measures improved in the post-intervention period. Additional multicenter studies are needed to develop national guidelines for perioperative prophylaxis for this population.

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

“…After a careful search for references, we identified an additional 8 of 48 papers relevant for the analysis. After the removal of duplicates, exclusion of reports other than original papers or reviews, and reports that did not fulfill the inclusion criteria, we identified 20 publications for the final analysis [1][2][3][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Detailed information included in these 20 papers is provided in Table 1.…”

“…What is interesting is that although some medical centers designed and implemented proper procedures, restricted observance of them could be problematic. Murray et al point to the fact that after a strict schedule implementation, timing of antibiotic prophylaxis was not proper in about 20% of patients, 27% of patients did not receive appropriate intra-operative redosing, and 84% had inadequate post-operative doses [17]. Surprisingly, after the implementation of an antibiotic prophylaxis protocol in this special group of patients, some authors observe that additional antibiotics for empirical treatment are initiated more often after the intervention than before (26.9% vs. 18.6%, respectively) [12].…”

“…In the papers reviewed, these antibiotics were often recommended, as in the adult population. Nevertheless, it has been confirmed that adult guidelines are safe to use also in neonatal infants [17]. In such infants, Alvares et al recommend ampicillin with an aminoglycoside as an alternative to cephalosporins [1].…”

Implementation strategies to reduce surgical site infections: A systematic review

“…Also, 14 studies (12%) evaluated a pediatric population, [33][34][35][36][37][38][39][40][41][42][43][44][45][46] and 111 (88%) evaluated an adult, mixed (adult and pediatric), or undefined population. We quantified the studies by surgical specialty: 21 cardiothoracic, 33,36,37,39,40,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] 22 orthopedic, 34,41,42,[62][63][64][65][66][67][68][69][70][71][72][73][74]...…”

Timing and Choice of Antibiotic Prophylaxis for Prevention of Surgical Site Infections: A Systemic Review

“…The 48 hour course has been shown to be similar to a 5 day course in prevention of SSI hence no need for prolongation beyond 48 hours [29][30][31]. Prolonged administration of antibiotics postoperatively was associated with complications including diarrhea due to Clostridium difficile colitis [32].…”