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Published on: February 9, 2011
Rationalizing irrational prescribing-infection-related attitudes and practices across paediatric surgery specialties
Surya Surendran1,2, Vrinda Nampoothiri1, Puneet Dhar3
1Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India.
Insights
Surgeons often overprescribe antibiotics in pediatric surgery due to outcome-driven decisions and beliefs about patient health. This leads to prolonged antibiotic use, even without diagnosed infections, impacting antimicrobial stewardship.
Area of Science:
- Pediatric Surgery
- Infectious Disease Management
- Antimicrobial Stewardship
Background:
- Antibiotic prescribing practices in pediatric surgical specialties remain understudied.
- Investigated antibiotic use in pediatric general and cardiovascular surgery in South India.
Purpose of the Study:
- To examine antibiotic prescribing patterns in pediatric surgical teams.
- To understand the factors influencing antibiotic decisions in pediatric surgery.
Main Methods:
- Mixed-methods approach: observations, interviews, and patient chart reviews.
- Thematic analysis of qualitative data and descriptive statistics for quantitative data.
- Iterative data collection until thematic saturation.
Main Results:
- Senior surgeons' experience heavily influences antibiotic prescribing, often leading to early prescription and reluctance to de-escalate.
- 83.3% of general surgery patients received antibiotics for their entire stay, with discharge prescriptions common.
- Antimicrobial stewardship teams had limited influence; surgeons attributed low surgical site infection rates to their practices.
Conclusions:
- Outcome-driven decision-making contributes to antibiotic overprescription and prolonged surgical prophylaxis.
- Surgeons' beliefs regarding health determinants in India complicate suboptimal antibiotic practices.
- Need for improved antimicrobial stewardship in pediatric surgical settings.
Background And Objectives:
Antibiotic use in paediatric surgical specialties is understudied. We investigated the antibiotic prescribing practices of paediatric general and cardiovascular surgical teams in a tertiary hospital in South India.
Methods:
Mixed-methods study including observations from ward rounds, semi-structured interviews, and review of antibiotic prescribing. Field notes from observations and interview transcripts were coded using NVivo and thematically analysed. Data collection and analysis were iterative and continued until thematic saturation. Quantitative data were analysed using descriptive statistics.
Results:
Data included 62 h of observation, 24 interviews, one case study and 200 patient chart reviews (100/specialty). Senior surgeons make key decisions, referring to their own experience when prescribing antibiotics. Being outcome-driven, the doctors often prescribe antibiotics at the earliest indication of infection with a reluctance to de-escalate, even when an infection is not diagnosed. This practice is more acute among surgeons who consider themselves responsible for their patients' health and attribute the consistently low surgical site infection rates to this practice.In general surgery, 83.3% (80/96; 4 lost to follow-up) of patients were prescribed antibiotics for the duration of their stay with oral antibiotics prescribed at discharge. The surgeons use antibiotics prophylactically for patients who may be vulnerable to infection. The antimicrobial stewardship team was considered to have limited influence in the decision-making process.
Conclusions:
Outcome-driven decision-making in surgery leads to overprescription of antibiotics and prolonged surgical prophylaxis. The rationale for suboptimal practices is complicated by the surgeons' beliefs about the contextual determinants of health in India.
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