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Related Experiment Videos

Eliminating Inappropriate Postoperative Antibiotics: A Stepped-Wedge Cluster Randomized Trial.

Jason G Newland1,2, Jingxia Liu3, Sara Malone4

  • 1Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri.

Pediatrics
|July 15, 2026
PubMed
Summary

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Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care01:30

Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care

A healthcare provider can diagnose a urinary tract infection (UTI) through several methods:Medical History and Symptoms: The provider will take a detailed medical history and ask about symptoms such as frequent urination, burning sensation during urination, and lower abdominal pain.Urinalysis: A clean-catch urine sample is collected in a sterile container and tested for the presence of bacteria, white blood cells (leukocytes), nitrites, blood, and protein. The presence of leukocytes and...
Antibiotic Selection00:57

Antibiotic Selection

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Antimicrobial stewardship teams did not significantly reduce unnecessary postoperative antibiotic duration with facilitation workshops. Further research is needed to understand how hospital context influences change strategies for antibiotic use.

Area of Science:

  • Healthcare Management
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Unnecessary postoperative antibiotic use is a widespread issue in healthcare settings.
  • This study investigates interventions to curb prolonged antibiotic administration post-surgery.

Purpose of the Study:

  • To evaluate the effectiveness of modifying electronic health record order sets combined with facilitation workshops by antimicrobial stewardship teams in reducing inappropriate postoperative antibiotic duration.
  • To compare this combined approach against modifying order sets alone.

Main Methods:

  • A stepped-wedge cluster randomized trial was conducted across 9 US children's hospitals from November 2020 to October 2023.
  • The primary outcome measured was the rate of inappropriate postoperative antibiotic duration exceeding 24 hours post-incision closure.

Related Experiment Videos

  • Secondary outcomes included any postoperative antibiotic use, surgical site infections (SSI), and Clostridioides difficile infections (CDI), analyzed using generalized estimating equations (GEEs).

    • Main Results:

    • The study included 18,267 patients; the experimental group (order set modification plus facilitation) showed a slightly lower rate of prolonged antibiotic use (10.05%) compared to the control group (11.02%), though this was not statistically significant in GEE analysis (P=.74).
    • No significant differences were observed between groups for any postoperative antibiotic use (45.1% vs 44.7%), SSI rates (1.96% vs 2.03%), or CDI rates (0.15% vs 0.06%).

    Conclusions:

    • Facilitation training, when added to order set modification, did not lead to a significant reduction in inappropriate postoperative antibiotic duration.
    • Understanding the influence of hospital context on the success of change strategies is crucial for future antimicrobial stewardship interventions.