Does compliance with antibiotic prophylaxis in pediatric simple appendicitis matter?
Krislynn M Mueck1, Luke R Putnam2, Kathryn T Anderson2
1Department of Surgery, University of Texas Health Science Center, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Health Science Center, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
The Journal of Surgical Research
|August 16, 2017
Summary
Adhering to an institutional protocol for antibiotic prophylaxis in pediatric appendectomies led to high compliance and reduced surgical site infections (SSIs). However, this resulted in antibiotic over-administration, highlighting the need for antibiotic stewardship.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Institutional protocols for preincisional antibiotic prophylaxis aim to standardize care and improve surgical outcomes.
- Challenges exist in adhering to these protocols for urgent or emergent surgeries.
- This study investigated compliance with an antibiotic prophylaxis protocol for pediatric appendectomies and its impact on surgical site infections (SSIs).
Purpose of the Study:
- To evaluate the compliance rate with an institutional protocol for antibiotic prophylaxis in pediatric patients undergoing appendectomy for simple appendicitis.
- To determine the association between protocol compliance and the incidence of surgical site infections (SSIs).
- To identify factors influencing compliance and noncompliance with the antibiotic prophylaxis protocol.
Main Methods:
- A retrospective study of pediatric patients (≤18 years) who underwent appendectomy for simple appendicitis between 2012 and 2015.
- Data collected included demographics, admission details, and outcomes, with specific assessment of antibiotic prophylaxis protocol compliance.
- Univariate analyses were used to identify factors associated with SSIs and protocol noncompliance.
Main Results:
- Overall compliance with antibiotic prophylaxis was 85% (590/697 patients), with high adherence to timing (91%), spectrum (95%), and drug choice (87%).
- Only 1.4% (10/697) of patients developed an SSI.
- Receipt of antibiotics within one hour of incision was significantly associated with decreased odds of SSI (OR 0.22).
Conclusions:
- The institutional appendicitis protocol demonstrated high compliance and contributed to low SSI rates.
- However, the protocol led to over-administration of antibiotics, indicating a need for improved antibiotic stewardship.
- Sustaining protocol compliance while practicing appropriate antibiotic stewardship is crucial for optimizing patient care.
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