Perioperative Antibiotic Prophylaxis in Pediatric Cardiac Surgery-Simple Is Better

Area of Science:

• Pediatric Cardiac Surgery
• Infectious Disease
• Antimicrobial Stewardship

Background:

• Perioperative antibiotic prophylaxis (PAP) is crucial for preventing surgical site infections (SSIs) in pediatric cardiac surgery.
• Challenges exist in optimizing PAP regimens due to procedural complexity and pediatric metabolic immaturity, impacting antimicrobial stewardship (AMS).
• Current practices often face deviations from established PAP protocols.

Purpose of the Study:

• To compare the efficacy and adherence of two PAP regimens in children undergoing elective cardiac surgery.
• To evaluate the impact of enhanced AMS interventions on PAP compliance and postoperative antibiotic use.
• To assess the rate of surgical site infections (SSIs) under different PAP strategies.

Main Methods:

• Retrospective analysis of a cefazolin with gentamicin PAP regimen.
• Prospective analysis of a cefazolin-only PAP regimen with integrated AMS measures (restricted cefazolin access, AMS team consultation).
• Comparison of SSI rates, PAP regimen deviations, and postoperative antibiotic use within 30 days.

Main Results:

• No significant difference in SSI rates between the prospective (1.2%) and retrospective (3.9%) groups (p = 0.35).
• Significantly reduced PAP violations in the prospective group (45.5% full compliance) compared to the retrospective group (4.8% full compliance) (p < 0.001).
• Reduced postoperative antibiotic use in the prospective group (0.991 DDD) versus the retrospective group (1.932 DDD).

Conclusions:

• Enhanced AMS interventions can significantly improve adherence to perioperative antibiotic prophylaxis in pediatric cardiac surgery.
• Optimized AMS strategies can reduce overall antibiotic exposure without compromising the prevention of surgical site infections.
• Cefazolin-only PAP, when combined with strict AMS oversight, appears effective and promotes better stewardship.