Antimicrobial Prophylaxis in Pediatric Surgical Patients: Identifying Targets for Improvement

Zoi Papanikolaou, Anastasia Dimopoulou, Katerina Mougkou, Georgia Kourlaba, Efthymios Choidis, Sofia Kouni, Stefania Maroudi-Manta, Susan Coffin, Theoklis Zaoutis, and Athanasia Lourida
Infectious Disease (ID) Week
San Francisco, California, October 2-6, 2013

BACKGROUND: Surgical site infection (SSIs) are the second most common healthcare-acquired infection (HAI) reported in children.  Guidelines for antimicrobial prophylaxis (AP) have been published. Data on the adherence to these guidelines are sparse in children. Determining adherence to these guidelines is particularly important in Greece because the rate of antimicrobial consumption and prevalence of multi-drug resistant organisms are amongst the highest observed in developed nations. The aim of the study was to determine current AP practices in pediatric surgery patients in Greece to identify opportunities for improvement. 

METHODS: A three-month prospective surveillance study of general surgical procedures was undertaken between January and March 2013 in the largest children’s hospital in Greece. Operative and medical records of all patients undergoing surgical procedures were reviewed to determine appropriateness of AP. 

RESULTS: A total of 153 patients underwent 153 surgical procedures. The most frequent procedures were appendectomy, 20.3% (31/153), inguinal hernia repair, 13.1% (20/153), orchiopexy, 12,4% (19/153), circumcision, 12.4% (19/153) and hydrocele repair, 7.2% (11/153). AP was administered to 94 of 153 patients (61.4 %), AP was indicated for 84/94 (89.4%). Of the 59 patients who did not receive AP, 55/59 (93.2%) underwent a procedure for which AP was indicated. The most common antimicrobials used for prophylaxis were ceforanide (39/94), metronidazole (22/94), cefoxitin (21/94), cefaclor (17/94) and cefprozil (14/94). The majority of patients 90/94 (95.7%) received AP beyond 24 hours. The median duration of AP was 7.5 (IQR: 5-10).

CONCLUSION: We found significant gaps in adherence to current SSI AP prophylaxis guidelines. Although we were not able to assess the timing of administration of AP or the need for redosing, we identified targets for intervention including improving compliance with AP for surgical procedures for which AP is recommended as well as antimicrobial stewardship targets regarding selection of antimicrobials and duration of AP.