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Appropriateness of Surgical Antibiotic Prophylaxis in Pediatric Patients in Italy

Published online by Cambridge University Press:  05 June 2017

Mariavalentina Giordano ,
Lorena Squillace  and
Maria Pavia
Mariavalentina Giordano
Affiliation:
Department of Health Sciences, University of Catanzaro “Magna Græcia,” CatanzaroItaly
Lorena Squillace
Affiliation:
Department of Health Sciences, University of Catanzaro “Magna Græcia,” CatanzaroItaly
Maria Pavia*
Affiliation:
Department of Health Sciences, University of Catanzaro “Magna Græcia,” CatanzaroItaly
*
Address correspondence to Maria Pavia, Chair of Hygiene, Department of Health Sciences Medical School, University of Catanzaro “Magna Græcia,” Via T. Campanella, 115, 88100 Catanzaro, Italy (pavia@unicz.it).
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Abstract

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 7 , July 2017 , pp. 823 - 831
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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