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Assessing the knowledge, attitudes and practices of physicians on perioperative antibiotic prophylaxis in pediatric
Yao Sun1, Chuan Sun1, Feng Chen1
1Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
Insights
Pediatric surgeons know guidelines for antimicrobial prophylaxis but don't always follow them, especially in high-risk areas. This knowledge-practice gap contributes to antimicrobial resistance (AMR).
Area of Science:
- Pediatric Surgery
- Infectious Disease
- Antimicrobial Stewardship
Background:
- Surgical site infection (SSI) prevention is key in pediatric surgery.
- Prolonged antimicrobial prophylaxis (PAP) drives antimicrobial resistance (AMR).
- Guideline adherence for discontinuing PAP within 24 hours is inconsistent.
Purpose of the Study:
- Evaluate pediatric surgeons' knowledge, attitudes, and practices (KAP) regarding PAP.
- Identify factors contributing to non-compliance with PAP guidelines.
- Analyze behavioral patterns using clustering.
Main Methods:
- Multicenter, cross-sectional survey of 143 pediatric surgeons in China.
- Validated questionnaire based on WHO guidelines.
- Spearman correlation and K-Means clustering for data analysis.
Main Results:
- High accuracy in drug selection (>84%) and timing (95.1%).
- Only 74.8% adhered to the 24-hour discontinuation guideline for clean incisions.
- A 'Knowledge-Practice Disassociation' pattern was found in Oncology, Burns, and SICU departments.
Conclusions:
- High cognitive reserve does not guarantee guideline adherence.
- Focus on SSI prevention over AMR may lead to defensive medicine and non-compliance.
- Further research is needed to verify this association in high-risk settings.
Background:
Surgical site infection (SSI) prevention is a critical component of pediatric surgical safety, yet the irrational prolongation of perioperative antimicrobial prophylaxis (PAP) remains a global driver of antimicrobial resistance (AMR). While guidelines explicitly recommend discontinuing prophylaxis within 24 h for clean incisions, compliance varies significantly. This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of pediatric surgeons regarding PAP and to identify the determinants of non-compliant behaviors using a novel clustering approach.
Methods:
A multicenter, cross-sectional study was conducted from July to August 2025 across Children's hospitals in Jiangsu Province, China. A total of 143 surgeons from different surgical departments (e.g., General Surgery, Orthopedics, Neurosurgery, Cardiothoracic Surgery) were surveyed using a validated questionnaire based on WHO guidelines. Data were analyzed using Spearman's rank correlation to assess knowledge-practice associations and K-Means clustering to identify distinct behavioral patterns among clinical departments.
Results:
The study achieved a valid response rate of 95.3%. While surgeons demonstrated high cognitive accuracy regarding drug selection (>84.0%) and administration timing (95.1%), only 74.8% acknowledged the standard of discontinuing prophylaxis within 24 h for Class I incisions. A significant positive correlation was found between knowledge and practice scores (r = 0.579, P < 0.001). However, cluster analysis revealed a "Knowledge-Practice Disassociation" pattern in the Oncology, Burns, and SICU departments.
Conclusion:
A high level of cognitive reserve cannot ensure consistent implementation of standard practices. In high-risk departments, clinicians' focus on SSI rather than AMR may trigger defensive medicine, which is likely to impair guideline adherence. This association requires further verification in targeted investigations.
