Increasing Compliance With an Antibiotic Prophylaxis Guideline to Prevent Pediatric Surgical Site Infection

So, Jeannette; Aleem, Ilyas; Tsang, Derek S.; Matlow, Anne; Wright, James G.

doi:10.1097/sla.0000000000000934

Cited by 43 publications

(45 citation statements)

References 31 publications

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“…In cases with post‐surgical devices such as chest drains, urinary catheters and implants, we found evidence of guideline‐non‐adherent extended post‐procedural SAP use, in some cases for up to 4 days. This has been noted in other studies despite a lack of evidence supporting this practice and recommendations to the contrary . There may be an exaggerated perception of SSI risk associated with devices and benefits of ongoing prophylaxis, leading to the overuse of antimicrobials.…”

Section: Discussionmentioning

confidence: 90%

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

Rizvi

Palasanthiran

et al. 2019

J Paediatrics Child Health

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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.

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Section: Discussionmentioning

confidence: 90%

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

Rizvi

Palasanthiran

et al. 2019

J Paediatrics Child Health

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“…Other reports in the medical literature describe interventions to increase compliance with recommended perioperative antibiotic prescribing practices, but these other reports mostly focus on the timing of the initial dose of PPA. 10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28] A limited number of reports focus on ensuring appropriate PPA redosing in prolonged surgeries 1 ; those that do document only modest improvements in the redosing rate. 12,13 We demonstrated that our multidisciplinary and multifaceted approach was effective at producing immediate and sustained improvements in guideline compliance, and the magnitude of benefit was much greater than in previous reports.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a multifaceted program to sustainably improve appropriate intraoperative antibiotic redosing

O'Sullivan

Rogers

Ackman

et al. 2019

American Journal of Infection Control

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“…Effective interventions are often multifaceted and have included interdisciplinary guideline development, prescriber feedback, educational initiatives, posters, checklists, and forced functions. [36][37][38][39][40][41] In the acute surgical setting, Weiser and colleagues 42 showed that the use of a surgical checklist is feasible, effectively improves adherence to antibiotic prophylaxis guidelines and reduces surgery-associated complications and mortality. A 3-phase surgical safety checklist (surgical briefing, surgical time out and surgical debriefing) has recently been implemented at our institution and may address some of these issues.…”

Section: Discussionmentioning

confidence: 99%

“…Despite interventions and the use of surgical checklists, full adherence to antibiotic guidelines in the operating room continues to be suboptimal. [6][7][8] As the population ages, older adults make up an increasing proportion of patients admitted to hospitals, and antibiotics play an important role in the management of many diseases. This is especially true of older patients who are admitted to acute care general surgery services, where antibiotics are routinely used for both treatment and prophylactic purposes.…”

mentioning

confidence: 99%

Antibiotic use among older adults on an acute care general surgery service

Pollmann

Bailey

Davis³

et al. 2017

CJS

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Background: Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital.Methods: Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines.Results: During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second-or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses. Conclusion:Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment.Contexte : Les antibiotiques jouent un rôle important dans de nombreux cas de chirurgie chez les adultes âgés, et le risque d'utilisation inappropriée de ces médicaments est élevé. Notre objectif était de décrire l'utilisation des antibiotiques chez les patients âgés admis au service chirurgical d'urgence d'un centre hospitalier universitaire de soins tertiaires.Méthodes : Nous avons recueilli de manière rétrospective les données détaillées sur le diagnostic, les comorbidités, la chirurgie et l'utilisation d'antibiotiques chez les patients de 70 ans et plus admis dans un service chirurgical d'urgence. Nous avons évalué le bien-fondé du recours aux antibiotiques (prophylaxie et traitement périopératoire) en fonction des lignes directrices publiées.

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Increasing Compliance With an Antibiotic Prophylaxis Guideline to Prevent Pediatric Surgical Site Infection

Abstract: A multifaceted intervention improved compliance with a pediatric AP guideline.

Cited by 43 publications

References 31 publications

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

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

Implementation of a multifaceted program to sustainably improve appropriate intraoperative antibiotic redosing

Antibiotic use among older adults on an acute care general surgery service

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