Surgical Antimicrobial Prophylaxis Among Pediatric Patients in South Africa Comparing Two Healthcare Settings

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Nicolene van der Sandt1, Natalie Schellack1, Lindi A Mabope2

  • 1From the Department of Pharmacy.

The Pediatric Infectious Disease Journal
|April 21, 2018
PubMed

Insights

Surgical antimicrobial prophylaxis (SAP) use in South African pediatric surgery deviates from guidelines. Both overuse and underuse were observed, with noncompliance mainly due to incorrect antimicrobial selection and dosing, highlighting the need for improved practices.

Area of Science:

  • Medical Research
  • Infectious Diseases
  • Surgical Care

Background:

  • Surgical antimicrobial prophylaxis (SAP) is crucial for patient outcomes, impacting morbidity, mortality, and healthcare costs.
  • Current knowledge regarding SAP practices in South Africa is limited.
  • Understanding SAP adherence is vital for optimizing patient care and resource allocation.

Purpose of the Study:

  • To evaluate compliance with established surgical antimicrobial prophylaxis (SAP) guidelines for pediatric surgical patients in South Africa.
  • To assess adherence across different hospital types and surgical subspecialties.
  • To identify specific areas of noncompliance within SAP protocols.

Main Methods:

  • A retrospective chart review was conducted over eight months (February-August 2015).
  • Data were collected from both a teaching hospital and a private hospital, analyzing 224 pediatric patient charts.
  • Prescribed SAP was compared against five key guideline criteria: selection, dosing, timing, redosing, and duration.

Main Results:

  • The majority of patients received indicated SAP (77.3% teaching, 100.0% private).
  • However, inappropriate antimicrobial use without indication was noted (21.1% teaching, 45.9% private).
  • Neither hospital fully complied with all five SAP criteria; the teaching hospital met 3 out of 5 criteria in 58.8% of cases.

Conclusions:

  • Current SAP practices in South African hospitals do not align with established guidelines.
  • Both overuse and underuse of SAP were identified, with noncompliance primarily linked to antimicrobial selection and dosing.
  • Quality improvement initiatives, ongoing surveillance, and localized, evidence-based SAP guidelines are essential for enhancing patient care.
Abstract

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