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Impact of a clinical pathway-based antimicrobial stewardship program on surgical antibiotic prophylaxis in pediatric

Seyyedeh Azam Mousavizadeh1, Bahador Mirrahimi2, Jamshid Salamzadeh1

  • 1Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

American Journal of Infection Control
|June 11, 2026
PubMed

Insights

A clinical pathway intervention improved surgical antibiotic prophylaxis (SAP) appropriateness in pediatric surgery, increasing overall appropriate SAP from 58.7% to 74.2%. This antimicrobial stewardship program reduced broad-spectrum agent use and enhanced compliance with guidelines.

Area of Science:

  • Pediatric Surgery
  • Antimicrobial Stewardship
  • Clinical Pathways

Background:

  • Pediatric surgical antibiotic prophylaxis (SAP) is frequently inappropriate, leading to unnecessary antimicrobial exposure.
  • Evaluating interventions to optimize SAP is crucial for combating antimicrobial resistance.

Purpose of the Study:

  • To assess the impact of a clinical pathway-based antimicrobial stewardship program on the appropriateness of SAP in pediatric surgery.
  • To determine if the intervention could improve compliance with established guidelines for SAP.

Main Methods:

  • A single-center, pre-post quasi-experimental study was conducted in a tertiary pediatric hospital.
  • The intervention involved pathway-based education, dosing aids, stocking first-line agents, and pharmacist feedback.
  • Compliance was measured using six guideline-defined elements for SAP in clean or clean-contaminated procedures.

Main Results:

  • Overall appropriate SAP increased significantly from 58.7% to 74.2% post-intervention.
  • Composite compliance for indicated-and-administered SAP cases rose from 74.9% to 85.0%.
  • Complete compliance increased from 52.6% to 71.4%, with increased use of cefazolin and decreased median doses of broader-spectrum agents.

Conclusions:

  • The pathway-based stewardship program was associated with improved SAP processes and reduced antimicrobial exposure in pediatric surgery.
  • Findings suggest a potential for enhanced antimicrobial stewardship through clinical pathway implementation.
  • Further multicenter studies with longer follow-up are recommended to confirm sustainability and clinical outcomes.
Abstract

Keywords:
ChildClinical pathwaysGuideline adherenceOperativeSurgical procedures

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