Quantifying Procedure-level Prophylaxis Misutilization in Pediatric Surgery: Implications for the Prioritization of Antimicrobial Stewardship Efforts
Related Experiment Video
Updated: Sep 5, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Seema P Anandalwar1, Carly Milliren2, Dionne A Graham2
1Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Insights
Antimicrobial prophylaxis is often misused in pediatric surgery, with over half of cases showing inappropriate use. Cholecystectomy and hernia repairs are key targets for improving antibiotic stewardship.
Area of Science:
- Pediatric Surgery
- Antimicrobial Stewardship
- Health Services Research
Background:
- Limited data exist to prioritize antibiotic stewardship efforts for prophylaxis in pediatric surgery.
- Optimizing antimicrobial use is crucial for patient safety and combating resistance.
Purpose of the Study:
- To quantify procedure-level inappropriate antimicrobial prophylaxis utilization in pediatric surgery.
- To identify high-priority targets for stewardship interventions.
Main Methods:
- Retrospective cohort analysis of 56,845 elective pediatric surgical cases (Oct 2015-Dec 2019).
- Assessed procedure-level compliance with guidelines for prophylaxis indication, spectrum, and duration.
- Calculated relative contribution of procedures to noncompliance for prioritization.
Main Results:
- Overall inappropriate antimicrobial prophylaxis utilization was 56%.
- Most common noncompliance: unindicated use (43%), prolonged duration (32%), broad spectrum (25%).
- Cholecystectomy, small bowel, and hernia repair procedures were associated with the highest rates of noncompliance.
Conclusions:
- Cholecystectomy, inguinal hernia repair, and small/large bowel procedures are high-priority targets for antimicrobial stewardship in pediatric surgery.
- Targeted interventions can improve appropriate antimicrobial prophylaxis utilization.
Objective:
To quantify procedure-level inappropriate antimicrobial prophylaxis utilization as a strategy to identify high-priority targets for stewardship efforts in pediatric surgery.
Background:
Little data exist to guide the prioritization of antibiotic stewardship efforts as they relate to prophylaxis utilization in pediatric surgery.
Methods:
This was a retrospective cohort analysis of children undergoing elective surgical procedures at 52 children's hospitals from October 2015 to December 2019 using the Pediatric Health Information System database. Procedure-level compliance with consensus guidelines for prophylaxis utilization was assessed for indication, antimicrobial spectrum, and duration. The relative contribution of each procedure to the overall burden of noncompliant cases was calculated to establish a prioritization framework for stewardship efforts.
Results:
A total of 56,845 cases were included with an overall inappropriate utilization rate of 56%. The most common reason for noncompliance was unindicated utilization (43%), followed by prolonged duration (32%) and use of excessively broad-spectrum agents (25%). Procedures with the greatest relative contribution to noncompliant cases included cholecystectomy and repair of inguinal and umbilical hernias for unindicated utilization (63.2% of all cases); small bowel resections, gastrostomy, and colorectal procedures for use of excessively broad-spectrum agents (70.1%) and pectus excavatum repair and procedures involving the small and large bowel for prolonged duration (57.6%). More than half of all noncompliant cases were associated with 5 procedures (cholecystectomy, small bowel procedures, inguinal hernia repair, gastrostomy, and pectus excavatum).
Conclusions:
Cholecystectomy, inguinal hernia repair, and procedures involving the small and large bowel should be considered high-priority targets for antimicrobial stewardship efforts in pediatric surgery.
More Related Videos
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:17Transmission-based Precautions I: Contact, Enteric, and Droplets
Contact Precautions:
Contact precautions are the measures taken to prevent the transmission of infectious agents, especially epidemiologically important microorganisms such as MRSA or influenza, primarily transmitted through direct or indirect contact with an...
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
01:28Antimicrobial Effectiveness