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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Beyond surgical care improvement program compliance: antibiotic prophylaxis implementation gaps.

Russell B Hawkins¹, Shauna M Levy, Casey E Senter

¹Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX, USA; The Children's Memorial Hermann Hospital, Houston, TX, USA.

American Journal of Surgery

|July 2, 2013

Summary

Documented compliance with antibiotic prophylaxis guidelines doesn't guarantee adherence. Actual adherence to antibiotic prophylaxis guidelines in pediatric surgery is low, potentially impacting surgical-site infection rates.

Keywords:

Adherence Antibiotic prophylaxis Compliance Implementation fidelity SCIP Surgical site infection

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Last Updated: May 10, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Area of Science:

Pediatric Surgery
Infectious Disease Control
Healthcare Quality Improvement

Background:

Surgical-site infections (SSIs) remain a challenge despite adherence to infection control measures.
The effectiveness of the Surgical Care Improvement Project (SCIP) infection measures is questioned due to stagnant SSI rates.

Purpose of the Study:

To evaluate if documented compliance with antibiotic prophylaxis guidelines on a pediatric surgery service reflects true implementation fidelity.
To determine adherence to intended antibiotic prophylaxis guidelines in pediatric surgical cases.

Main Methods:

An observational study was conducted over 7 weeks involving elective pediatric surgical cases.
Adherence to antibiotic prophylaxis guidelines was assessed for administration, type, timing, weight-based dosing, and redosing.

Main Results:

While 99% of cases had appropriate antibiotic administration, only 48% adhered to all 5 guideline components when prophylaxis was indicated.
Documentation in electronic medical records showed 100% compliance, but actual adherence was significantly lower, mainly due to dosing and timing errors.

Conclusions:

Suboptimal implementation fidelity of antibiotic prophylaxis guidelines may contribute to the persistence of SSIs.
Future research on SCIP effectiveness should prioritize measuring adherence and implementation fidelity over mere documented compliance.