Perioperative Antibiotic Prophylaxis for Heart Transplantation at Children's Hospitals in the United States

Data on perioperative antibiotic use for pediatric heart transplantation are scarce. Such information can help identify opportunities for improvement and/or standardization.

We performed a retrospective analysis using the Pediatric Health Information System database. Children <18 years old undergoing heart transplantation at hospitals performing 50 or more transplantations over a 20-year period were included. Primary outcomes of interest were perioperative antibiotics other than cefazolin monotherapy and prolonged postoperative duration (>1 day). The primary exposure of interest was heart transplantation volume in the hospital, classified by the quartiles of case counts, with the first quartile including the lowest-volume hospitals.

Cefazolin monotherapy was used in >50% of cases at 11 of 28 hospitals (39.3%). Twelve of 28 hospitals (42.9%) used multiple perioperative antibiotics in >50% of cases. Antibiotics were continued for >1 calendar day in more than two-thirds of transplantations (69.4%). Antibiotic regimens other than cefazolin monotherapy were less likely to be used at higher-volume hospitals (odds ratio: 0.45; 95% confidence interval: 0.38-0.53 for the fourth quartile hospitals). Antibiotics were continued for >1 calendar day in more than two-thirds of transplantations (69.4%) with a median postoperative duration of 2 calendar days (interquartile range: 1-3).

Perioperative antibiotic use for heart transplantation varies substantially across children's hospitals, and adherence to national guidelines seemed suboptimal. The insights gained through this study should serve as an initial step for identifying opportunities for improvement and/or standardization to identify the best clinical practice.