Related Experiment Video
Updated: Jun 27, 2026
07:13
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Perioperative Prophylaxis in Pediatric Solid Organ Transplantation: A Baseline Stewardship Audit Using Routine
Charles B Foster1, Kaitlyn Rivard2, Venkatraman A Arakoni3
1Section of Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio, USA.
Summary
Antibiotic prophylaxis timing and initial regimens in pediatric transplants were mostly successful. However, extended antibiotic use post-transplant, especially in abdominal cases, needs improvement for better antimicrobial stewardship.
Area of Science:
- Pediatric Solid Organ Transplantation
- Antimicrobial Stewardship
- Quality Improvement
Background:
- Perioperative antibacterial prophylaxis protocols vary significantly across pediatric solid organ transplant centers.
- Standardizing protocols is crucial for establishing baseline stewardship measures and guiding future quality improvement initiatives.
Purpose of the Study:
- To evaluate adherence to institutional perioperative antibacterial prophylaxis protocols in pediatric solid organ transplantation.
- To identify areas for improvement in antimicrobial stewardship and quality-of-care.
Main Methods:
- Retrospective analysis of 164 pediatric transplants (2010-2021).
- Assessment of on-time dosing, regimen selection, targeted add-on agents (MRSA, VRE), anaerobic coverage, Gram-negative broadening, and discontinuation timing.
- Utilized anesthesia and medication data to evaluate protocol concordance and exposure patterns.
Main Results:
- High adherence to on-time dosing (95.7%) and initial recommended regimens (87.2%).
- Suboptimal discontinuation rates (61.0%), particularly in intestinal and multivisceral transplants.
- Increased use and duration of MRSA-directed add-ons in abdominal transplants; protocol-linked antibiotic continuation beyond target windows observed in 8.6% of therapy days.
Conclusions:
- Pediatric transplant antibiotic prophylaxis demonstrates strong initial timing and regimen selection.
- Antibiotic continuation beyond protocol cutoffs in abdominal transplantation is a key area for prospective review and improvement.
- Routine electronic data can generate reproducible measures and organ-specific targets for stewardship and quality improvement.
Related Concept Videos
01:26Kidney Transplant II: Surgical Procedure
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...
01:16Kidney Transplant III: Nursing Management
Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
01:28Kidney Transplant I: Introduction
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses a challenge in...