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Antibiotic prophylaxis for neonatal surgery: Evaluation of the implementation of a new protocol based on "less could
M José Sánchez de Toro1, Mercedes Sampedro Martín1, Celia Permuy Romero1
1Neonatology service, La Paz University Hospital, Madrid, Spain.
Insights
A new neonatal surgical prophylaxis protocol reduced antibiotic duration and dose without increasing surgical site infections. This evidence-based approach is feasible for vulnerable neonates.
Area of Science:
- Neonatal surgery
- Infectious disease prevention
- Antibiotic stewardship
Background:
- Surgical site infections (SSIs) increase neonatal morbidity, mortality, and healthcare costs.
- Neonates possess immature immune systems, making them highly susceptible to infections.
- Limited evidence for neonatal surgical prophylaxis necessitates broad-spectrum, extended antibiotic use.
Purpose of the Study:
- To assess the impact of a new neonatal surgical prophylaxis protocol.
- To restrict antibiotic use to specific indications and limited durations.
- To align neonatal prophylaxis with evidence from pediatric and adult populations.
Main Methods:
- A case-control study compared a new protocol (March 2022-March 2023) with historical controls (March 2019-March 2020).
- Analyzed perinatal, surgical, and prophylactic antibiotic variables, including protocol adherence and infectious complications.
- Included 90 procedures in the intervention group and 116 in the control group.
Main Results:
- The new protocol significantly reduced antibiotic therapy duration (72h vs 48h) and cumulative dose.
- No increase in infectious complications was observed (6.4% vs 10.1%, p=0.343).
- Patient and surgical characteristics were comparable between groups.
Conclusions:
- A narrower-spectrum, shorter-duration surgical prophylaxis protocol is safe for neonates.
- This approach does not elevate the incidence of surgery-related infections in this population.
- The protocol's development and implementation were feasible within a multidisciplinary setting.
Abstract:
IntroductionSurgical site infections are associated with increased postoperative morbidity and mortality, as well as prolonged hospitalization and higher costs. Neonates have an immature immune system, rendering them a susceptible population. Evidence regarding surgical prophylaxis in this age group is limited, which has led us to employ broad-spectrum antibiotic therapy for an extended duration.ObjectivesTo evaluate the impact of a new neonatal surgical prophylaxis protocol, based on available evidence in pediatric and adult populations, aimed at restricting antibiotic prescription to this indication and for a limited period of time.Materials and MethodsA case (intervention group receiving the new protocol from March 2022 to March 2023) and a control (historical cohort from March 2019 to March 2020 that received the existing prophylaxis at that time) study was conducted. Perinatal and surgical variables, prophylactic antibiotic therapy, adherence to the protocol and infectious complications were analyzed.ResultsA total of 90 procedures from the intervention group and 116 from the control group were analyzed, with comparable characteristics. The protocol change resulted in a reduction in the duration of antibiotic therapy and a decrease in the cumulative dose (72 h vs 48 h, p < 0.001) without an increase in infectious complications (6.4% vs 10.1%, p = 0.343).ConclusionsThe use of a surgical prophylaxis protocol with a narrower spectrum and shorter duration does not increase the incidence of surgery-related infections in neonatal patients. Despite the multidisciplinary nature of the professionals caring for these patients, the development and implementation of this new protocol have been feasible in our setting.
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