An evaluation of antimicrobial prophylaxis in paediatric surgery and its financial implication

Area of Science:

• Paediatric Surgery
• Infectious Disease Management
• Pharmacoeconomics

Background:

• Antimicrobial prophylaxis is crucial in paediatric surgery to prevent surgical site infections.
• Adherence to established guidelines ensures optimal efficacy and minimizes antimicrobial resistance.
• Previous studies indicate variability in prophylaxis practices globally.

Purpose of the Study:

• To evaluate the appropriateness of antimicrobial prophylaxis administration in paediatric surgical procedures in Singapore.
• To identify specific areas of non-compliance with prophylaxis guidelines.
• To assess the economic impact of inappropriate antimicrobial use.

Main Methods:

• A prospective study conducted from September to December 2001 at KK Hospital, Singapore.
• Evaluated 171 paediatric patients undergoing elective and emergency surgery.
• Assessed adherence to guidelines, choice, dose, timing, and duration of antimicrobial prophylaxis, alongside cost analysis.

Main Results:

• Only 12.8% of paediatric surgical procedures were fully compliant with prophylaxis guidelines.
• Common non-compliance issues included prolonged prophylaxis (54.4%), inappropriate antibiotic choice (42.7%), and incorrect dosage (26.3%).
• Estimated excess costs due to inappropriate antimicrobial use amounted to S$13,879.41 (US$8,164.36).

Conclusions:

• A high rate of inappropriate antimicrobial prophylaxis use was observed in Singaporean paediatric surgery.
• While overall non-compliance was high, individual factors like antibiotic choice and timing mirrored international findings.
• The study underscores the need for improved adherence to antimicrobial prophylaxis guidelines to enhance patient outcomes and reduce healthcare costs.