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Clinical practice audit concerning antimicrobial prophylaxis in paediatric neurosurgery: results from a German
Katja Weiss1, Arne Simon1, Norbert Graf1
1Paediatric Oncology and Haematology, University Hospital Children's Clinic, 66421, Homburg, Saar, Germany.
Insights
This audit of perioperative antimicrobial prophylaxis (PAP) in paediatric oncology patients found significant issues with antibiotic dosing and selection, despite no surgical site infections (SSIs) being detected. Improvements in clinical practice are needed for optimal antibiotic use in neurosurgery.
Area of Science:
- Oncology
- Infectious Diseases
- Pharmacology
Background:
- Perioperative antimicrobial prophylaxis (PAP) is crucial for preventing surgical site infections (SSIs) in paediatric oncology patients undergoing neurosurgery.
- Judicious antibiotic use is a key target for internal audits in healthcare settings.
- Paediatric oncology patients with brain tumours have an elevated risk of SSI post-neurosurgery.
Purpose of the Study:
- To conduct a comprehensive audit of perioperative antimicrobial prophylaxis (PAP) practices in paediatric oncology patients undergoing neurosurgery.
- To identify opportunities for improving the clinical application of PAP guidelines.
- To assess the adherence to internal PAP guidelines and their impact on SSI rates.
Main Methods:
- Systematic audit of clinical data for paediatric oncology patients (<18 years) undergoing neurosurgery.
- Data collection divided into retrospective (Jan 2012-Mar 2014) and prospective (Apr 2014-Mar 2015) phases, following guideline implementation in Jan 2014.
- Surveillance of SSIs up to 30 days post-operation using standard CDC criteria.
Main Results:
- Analysis of 53 neurosurgical operations in 33 paediatric oncology patients revealed suboptimal PAP practices.
- Common deviations included incorrect cefuroxime dosing (30 mg/kg vs. 50 mg/kg), lack of redosing for long procedures, and inappropriate use of cefotaxim (23% retrospective, 18% prospective).
- Extended PAP duration (>24 hours) was common (66% retrospective, 60% prospective), with no SSIs detected in either group.
Conclusions:
- Significant opportunities exist to enhance PAP clinical practice in paediatric oncology neurosurgery regarding antibiotic choice, dosing, timing, and duration.
- The study highlights challenges in implementing evidence-based guidelines into standard clinical workflows.
- Despite deviations from guidelines, no SSIs were observed, suggesting potential for optimizing prophylaxis without compromising patient safety.
Background:
Perioperative antimicrobial prophylaxis (PAP) has been identified as an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients with brain tumours face an increased risk of surgical site infection (SSI) after neurosurgery and receive routine PAP in this setting.
Patients And Methods:
All patients younger than 18 years admitted to the paediatric oncology centre (POC) with a neurosurgical intervention. Systematic audit of routine clinical data is divided in two groups: retrospective (Jan 01, 2012-March 31, 2014) and prospective (April 01, 2014-March 31, 2015) referring to an internal PAP guideline, invented in Jan. 2014). Surveillance of SSI up to 30 days after the operation with standard criteria (Centres for Disease Control and Prevention, USA).
Results:
In total, 53 neurosurgical operations were analysed in 33 paediatric oncology patients. Twelve patients received more than one operation. The detailed analysis of PAP revealed prophylactic cefuroxim doses about 30 mg/kg instead of 50 mg/kg and no repeated dosing in operations lasting longer than 4 h. In addition, Cefotaxim, which is not indicated as PAP in neurosurgery, was used instead of Cefuroxim (or Ampicillin-Sulbactam) in 23 % of all cases in the retrospective and 18 % of all cases in the prospective audit. PAP for more than 3 doses (>24 h) was administered in 66 % in the retrospective group and in 60 % in the prospective group (p = n.s.). In both groups, no SSI was detected.
Discussion:
This first comprehensive audit of PAP in paediatric oncology patients undergoing neurosurgery outlines significant opportunities to improve clinical practice in terms of correct dosing, the correct choice of the antibiotic, a correct timing schedule and a shorter duration of PAP. In addition, our results illustrate in detail the challenges in clinical practice when an evidence-based approach to improve a standard workflow has to be implemented.