infection control & hospital epidemiology july 2017, vol. 38, no. 7 original article
Appropriateness of Surgical Antibiotic Prophylaxis in Pediatric Patients in Italy
Mariavalentina Giordano, MD; Lorena Squillace, MD; Maria Pavia, MD, MPH
objectives. Appropriate use of surgical antibiotic prophylaxis (SAP) reduces intraoperative wound contamination in pediatric surgery, thus minimizing the risk of surgical site infection (SSIs). Conversely, inappropriate use of SAP exposes patients to the risk of antibiotic side effects and contributes to the emergence of antimicrobial resistance. Our aims were to describe SAP administration and to analyze factors associated with nonadherence in pediatric patients.
design. Descriptive study. setting. Overall, 955 pediatric patients underwent 1,038 surgical procedures.
methods. We assessed adherence to SAP international guidelines for surgical procedures performed on children aged <18 years in 2015 in 4 randomly selected hospitals in Calabria (Italy). The clinical records of these patients were retrospectively reviewed.
results. Appropriate SAP administration or nonadministration pertained to 754 surgical procedures (72.6%). Surgical antibiotic prophylaxis was administered in 88.5% of 358 procedures with an SAP indication. Adherence to guidelines for appropriate drug choice were followed in 5.7% of cases, for route of administration in 76.7%of cases, for timing in 48.6%of cases, for duration in 14.5%of cases, and for dose in 91.5%of cases, and for all components in only 5 cases (1.6%). Among 680 procedures without SAP indication, 35.7% case patients received antibiotics. Inappropriate administration of antibiotics in procedures without SAP indication was associated with surgical specialty wards (P=.008), ordinary admission (P<.001), head and neck surgical procedures (P=.020), clean surgery (P=.017), and surgical duration (P=.010).
conclusions. Discrepancies between SAP guidelines and actual practice behavior more frequently indicate excessive use of antibiotics than underuse. Increased awareness of SAP guidelines is required.
Infect Control Hosp Epidemiol 2017;38:823–831
Surgical site infections (SSIs) are common but potentially avoidable complications of adult and pediatric surgery; they contribute significantly to postoperative morbidity and mortality.1 The incidence of SSIs in pediatric populations ranges from 2.5% to 20%.2 Several measures have proven effective in preventing SSIs, including the use of aseptic condi- tions and techniques in the operating room, appropriate patient preparation, and the use of surgical antibiotic prophylaxis (SAP) before and during surgery.3 Indeed, appropriate use of SAP reduces intraoperative wound contamination and mini- mizes the risk of SSIs of procedures for which it is indicated. Conversely, inappropriate use of SAP when it is indicated and administration of antibiotics when they are not indicated are potentially harmful practices; they expose patients to the risk of antibiotic side effects and complications, such as Clostridium difficile infection (a cause of antibiotic-associated colitis) and contribute to the emergence of antimicrobial resistance.4,5 Guidelines for SAP in adult patients are well defined, even if numerous studies have shown that overall adherence to
recommendations is hard to achieve.6–12 Conversely, the use of SAP for pediatric patients is inadequately characterized, although SAP guidelines with recommendations are available regarding appropriate drug choice, timing, route, dose, and duration.13,14 The few reports on SAP in pediatric patients have demonstrated that nonoptimal adherence is related to overuse in surgical interventions where there is no indication for prophylaxis or underuse of SAP when indicated, inappropriate use of third-generation cephalosporins, and administration of SAP for longer than 24 hours.15–17 The aims of this study were to describe SAP administration
and to analyze factors associated with nonadherence in pediatric patients.
methods
The study cohort included patients with the following characteristics: younger than 18, admitted between January 1 and December 31, 2015, to any of 4 randomly selected
Affiliation: Department of Health Sciences, University of Catanzaro “Magna Græcia,” Catanzaro Italy.
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3807-0009. DOI: 10.1017/ice.2017.79 Received December 13, 2016; accepted March 27, 2017; electronically published June 5, 2017
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