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Preoperative Antibiotic Compliance and Colorectal Surgical Site Infection in Children
Lauren R Templeton1, Zachary M Most2, Maria V Bradd3
1UT Southwestern Medical Center, School of Medicine, Dallas, Texas.
Insights
Implementing a surgical bundle reduced superficial surgical site infections (SSIs) in pediatric colorectal surgery (CRS) patients. However, antibiotic selection and timing alone did not independently predict SSI reduction.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Surgical site infections (SSIs) are a concern in pediatric colorectal surgery (CRS).
- Existing evidence supports SSI prevention bundles in adult CRS.
- The role of preoperative antibiotic selection and timing in pediatric CRS SSI rates requires investigation.
Purpose of the Study:
- To evaluate the association between preoperative antibiotic selection/timing and SSI incidence in pediatric CRS patients.
- To assess the impact of a surgical bundle on SSI rates in this population.
Main Methods:
- Retrospective analysis of a prospectively collected cohort (2019-2022).
- Comparison of SSI incidence before and after implementing a surgical bundle focused on antibiotics.
- Categorization of antibiotic compliance and SSI types; logistic regression analysis.
Main Results:
- SSI rates decreased by 44% post-bundle implementation.
- Compliance with the surgical bundle increased from 56% to 88%.
- Antibiotic selection and timing were not independent predictors of SSI reduction.
Conclusions:
- Perioperative surgical bundle implementation is associated with reduced superficial SSIs in pediatric CRS.
- Specific adherence to antibiotic selection and timing alone did not predict SSI reduction.
- Surgical bundles may be beneficial for SSI reduction in pediatric CRS.
Introduction:
Surgical site infection (SSI) prevention "bundles" have been shown to reduce rates of SSI in adult colorectal surgery (CRS) patients. Our purpose was to investigate the association between selection and timing of preoperative antibiotics and incidence of SSI in pediatric CRS patients.
Methods:
We performed a retrospective analysis of a prospectively collected cohort study spanning January 2019-December 2022 comparing the incidence of SSI in all pediatric CRS patients at a single institution before and after implementation of a surgical "bundle" focused on appropriate selection and timely administration of prophylactic antibiotics. Antibiotic selection and timing were each categorized compliant or noncompliant. SSIs were stratified into superficial, deep incisional, and organ space infections. The primary outcome was incidence of SSI within 30 d of operation. Logistic regression analysis was performed.
Results:
Full compliance was noted in 56% of cases in the prebundle cohort and 88% of cases in the postbundle cohort. SSI rates were decreased by 44%. A logistic regression model failed to identify antibiotic selection or timing as an independent predictor of SSI.
Conclusions:
The implementation of this perioperative surgical bundle was associated with a reduction in superficial SSI in pediatric CRS patients. Notably, specific adherence to antibiotic selection and timing of administration alone were not found to be predictive for reduction in SSI rates. These findings may support the use of surgical bundles in SSI reduction in pediatric patients undergoing CRS.
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