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.
Insights
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.
Background:
Institutional protocols for preincisional antibiotic prophylaxis can standardize care and improve outcomes. However, challenges remain in compliance with such protocols for urgent or emergent operations. We hypothesized that compliance with an institutional protocol for antibiotic prophylaxis for appendectomy for appendicitis in pediatric patients results in reduced surgical site infections (SSIs) after simple appendectomy.
Methods:
This retrospective study assessed all pediatric patients (≤18 y) who underwent appendectomy for confirmed simple appendicitis at a tertiary children's hospital between 2012 and 2015. Demographic, admission, and outcome data were recorded. Compliance with the protocol was assessed. Univariate analyses were performed to identify factors associated with any SSI and protocol noncompliance.
Results:
Overall compliance with antibiotic prophylaxis occurred in 590 of 697 patients (85%). Compliance was high with timing (91%), spectrum (95%), and protocol-recommended drug (87%). Admission antibiotics alone were administered in 65 patients (9%), preincisional antibiotics alone in 254 patients (36%), and both in 378 patients (55%). Patients included in the analysis received a median of 2 (range 1-6) doses of antibiotics preoperatively. Ten patients (1.4%) developed an SSI. Only receipt of any antibiotics within an hour of incision was associated with decreased odds of SSI (odds ratio 0.22, 95% confidence interval 0.06-0.87). No factors were associated with noncompliance.
Conclusions:
An institutional appendicitis protocol yields high compliance with prophylactic antibiotic administration and associated low SSI rates, but at a cost of antibiotic over-administration. Further efforts are necessary to sustain compliance while also practicing appropriate antibiotic stewardship.
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