Trends in the use of surgical antibiotic prophylaxis in general pediatric surgery: Are we missing the mark for both stewardship and infection prevention?

Anandalwar, Seema P.; Milliren, Carly E.; Hills–Dunlap, Jonathan L.; Kashtan, Mark A.; Newland, Jason G.; Rangel, Shawn J.

doi:10.1016/j.jpedsurg.2019.09.057

Cited by 14 publications

(19 citation statements)

References 23 publications

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“…However, a deeper analysis of paediatric studies seems to indicate that antibiotic prophylaxis can also be effective in children, although with a lower efficacy than adults. In a retrospective study in which no reduction of infections after preoperative antibiotic prophylaxis was found, antibiotic use was associated with a lower fever, less frequent stoma leakage, and a shorter duration of hospitalization [ 14 ]. In a second retrospective study, without any reduction in the infection incidence in response to antibiotics, children receiving placebo had a significantly higher mean body temperature after PEG insertion, suggesting that prophylaxis could reduce the risk of bacteremia [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…Attempts to identify which surgical patients were more prone to SSIs, which pathogens were more frequently associated with SSIs, which antibiotics could be more effective, and which were the most appropriate prescriptive modalities were made [ 10 , 11 , 12 , 13 ]. Despite this, definitive recommendations could be made for only some surgeries, as for several of them, randomized, double-blind, placebo-controlled studies comparing patients that were receiving different antibiotic options to placebo or no prophylaxis were not available [ 14 ]. This is even more evident in children, a group of patients who, especially in the first years of life, are at the highest risk of infections.…”

Section: Introductionmentioning

confidence: 99%

“…This is even more evident in children, a group of patients who, especially in the first years of life, are at the highest risk of infections. Studies in children are scarce, and the use of antibiotic prophylaxis among children is exposed to risks of mistakes, even more so than in adults [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study

et al. 2022

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Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible since about 50% of SSIs occur after the hospital discharge. Gastrointestinal surgical procedures are among the surgical procedures with the highest risk of SSIs, especially when colon surgery is considered. Data that were collected from children seem to indicate that the risk of SSIs can be higher than in adults. This consensus document describes the use of preoperative antibiotic prophylaxis in neonates and children that are undergoing abdominal surgery and has the purpose of providing guidance to healthcare professionals who take care of children to avoid unnecessary and dangerous use of antibiotics in these patients. The following surgical procedures were analyzed: (1) gastrointestinal endoscopy; (2) abdominal surgery with a laparoscopic or laparotomy approach; (3) small bowel surgery; (4) appendectomy; (5) abdominal wall defect correction interventions; (6) ileo-colic perforation; (7) colorectal procedures; (8) biliary tract procedures; and (9) surgery on the liver or pancreas. Thanks to the multidisciplinary contribution of experts belonging to the most important Italian scientific societies that take care of neonates and children, this document presents an invaluable reference tool for perioperative antibiotic prophylaxis in the paediatric and neonatal populations.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study

et al. 2022

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“…Segala et al reported that the adherence to perioperative prophylaxis guidelines before the implementation of antimicrobial stewardship was only 36.6% and increased after their intervention [13]. Moreover, Anandalwar et al reported that regarding the use of surgical antibiotic prophylaxis in general pediatric surgery, 44% of the cases received inappropriate prophylaxis, of which 42% were considered overtreatment and 58% were considered undertreatment [14]. Karaali et al found that in the pre-intervention phase of their study, the rate at which all stages of surgical prophylaxis were adhered to was found to be low [15].…”

Section: Appropriateness Of Surgical Prophylaxismentioning

confidence: 99%

Review of the Appropriateness of Surgical Antimicrobial Prophylaxis

Ahmed

Almalki

Haseeb

et al. 2021

JPRI

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Aim: This review aims to describe the appropriateness of surgical antimicrobial prophylaxis during the last decade. Methodology: The review included a searching web of science for articles focused on “the appropriateness of surgical antimicrobial prophylaxis”. The searching process was conducted on 29 Nov 2020 and included original articles so the review articles were excluded. Results: The review included 57 articles; 38 articles were published after 2015 and the rest before 2015. Most of the articles that were included in the review showed a high rate of inappropriate surgical prophylaxis and showed inappropriate duration and time of the antibiotics used. Conclusion: It can be concluded that the rate of surgical prophylaxis inappropriateness was high and the main cause for this result was inappropriate timing and duration. Numerous interventions including educational interventions such as one-time seminars and online e-learning modules are needed to improve the adherence to the guidelines.

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“…A recent study conducted in a Chinese pediatric hospital revealed that 59.6% patients received inappropriate empirical therapy [ 7 ]. In a US study, 44% of children undergoing elective clean-contaminated and clean surgical procedures with foreign body implantation received inappropriate prophylaxis [ 8 ]. Therefore, the inappropriate use of antimicrobial drugs in hospitals is a problem not restricted to China.…”

Section: Introductionmentioning

confidence: 99%

Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys

Gao

Guo

et al. 2020

BMC Infect Dis

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Background Misuse and overuse of antibiotics by physicians in the treatment of children is common in China. This study aimed to reveal the overall use of antibiotics to treat children hospitalized in four types of pediatric wards. Methods Seven independent point prevalence surveys (PPSs) were conducted in Shanghai Children’s Hospital of Shanghai Jiao Tong University over the period 2012 to 2018. Pediatric ward types were defined general pediatric medical, pediatric surgical, pediatric intensive care units (PICU), and neonatal. Results A total of 3975 pediatric patients were included in the study, of which 63.9% received at least one dose antibiotic. The top five classes of antibiotics administered were cephalosporins (43.8%, n = 1743), penicillins (13.2%, n = 526), carbapenems (8.7%, n = 347), nitroimidazoles (7.1%, n = 281) and macrolides (6.5%, n = 257). The five most commonly used generic antibiotics were cefuroxime (14.9%, n = 594), ceftriaxone (9.7%, n = 387), cefotaxime (9.0%, n = 358), meropenem (8.1%, n = 320) and ampicillin/sulbactam (6.0%, n = 239). Meropenem was among top five antibiotics prescribed in the general pediatric, PICU and neonatal wards and sixth in the pediatric surgical wards. Of all children on antibiotics, 23.4% received prophylactic treatment, and prophylaxis accounted for 68.1% of indications for treatment in the pediatric surgical wards. Conclusions Given that over-treatment with third-generation cephalosporins and carbapenems has been associated with treatment-resistant infections, the prescription of these drugs should be strictly controlled and monitored, and measures should be taken to improve the management of surgical prophylaxis in hospitalized children in China.

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Trends in the use of surgical antibiotic prophylaxis in general pediatric surgery: Are we missing the mark for both stewardship and infection prevention?

Cited by 14 publications

References 23 publications

Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study

Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study

Review of the Appropriateness of Surgical Antimicrobial Prophylaxis

Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys

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