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Pathan SR, Bhende VV, Sharma TS, Kumar A, Patel VA, Sharma KB, Pandya SB. Antibiotic Utilization and Prophylaxis in Paediatric Cardiac Surgery: A Retrospective Observational Study at a Rural Tertiary Care Hospital in India. Cureus 2023; 15:e45107. [PMID: 37842391 PMCID: PMC10569353 DOI: 10.7759/cureus.45107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Antimicrobial prophylaxis, involving short antibiotic courses preceding surgical procedures, is recommended to minimize postoperative infections. Paediatric cardiac surgeries are classified as clean procedures, though infection challenges persist due to illness severity and extended ICU stays. Antimicrobial prophylaxis varies, ranging from single doses to extended administration until catheters are removed. Typically lasting 24 to 48 hours, it has proven infection-reduction benefits. Despite these practices, uncertainties surround the optimal nature, timing, and duration of administration. This concern is amplified by escalating antimicrobial resistance driven by antibiotic overuse. Vulnerable paediatric populations bear heightened consequences of irrational antimicrobial use, contributing to global resistance trends. Yet, a defined optimal prophylaxis schedule for paediatric cardiac surgery is lacking. Importing adult guidelines may be inadequate due to paediatric research complexities and population diversity. Developing effective prophylaxis protocols is crucial for children undergoing cardiac surgery, given global antibiotic overuse and evolving drug resistance. Establishing an optimal prophylactic strategy remains a challenge, necessitating further research for evidence-based protocols to mitigate infections in this vulnerable patient cohort. Methods This study investigates antibiotic use in paediatric cardiac surgery. A retrospective analysis of 100 patients from a rural Indian hospital (2017-2018) assesses antibiotic patterns, including type, dose, duration, and adherence to prophylaxis protocols. Results In the studied cohort of paediatric cardiac surgery patients, complete compliance (100%) with antibiotic prophylaxis was observed. However, deviations were identified: 30% received antibiotics prematurely, and 30% did not align with institutional protocol criteria. Concerning antibiotic selection, 87% followed hospital policy with the recommended cefoperazone and sulbactam combination plus amikacin, while 9% received piperacillin/tazobactam + amikacin due to sepsis. Irregular use (22%) based on clinical records occurred. Furthermore, 4% received piperacillin/tazobactam + teicoplanin, with one instance of inappropriate higher antibiotic use. Regarding prophylaxis duration, only 27% adhered to the appropriate timeline, with 40% exceeding 48 hours, indicating extended use. Upon discharge, a notable proportion (45 patients) received antibiotic prescriptions. Among them, 73% were prescribed rationally, while 27% exhibited irrational antibiotic use. Conclusion The findings of this study shed a significant light on the issue of antibiotic misuse within the context of paediatric cardiac surgery. It underscores the pressing need for more stringent measures to regulate and address this concerning trend. The study underscores the pivotal importance of adhering rigorously to established protocols and guidelines for antibiotic prophylaxis. This adherence not only holds the potential to elevate the overall quality of patient care but also plays a critical role in combating the escalating challenge of antibiotic resistance. Through a concerted effort to optimize antibiotic usage, we can simultaneously enhance patient outcomes and contribute to the ongoing fight against the emergence of antibiotic-resistant strains, thus preserving the efficacy of these vital medications for future generations.
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Affiliation(s)
- Sohilkhan R Pathan
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Vishal V Bhende
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Tanishq S Sharma
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Amit Kumar
- Pediatric Cardiac Intensive Care, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Vishal A Patel
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Kruti B Sharma
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Shivangi B Pandya
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
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Jaworski R, Dzierzanowska-Fangrat K, Grzywa-Czuba R, Kansy A. Postoperative kinetics of pentraxin 3 (PTX3) after congenital heart surgery with cardiopulmonary bypass in pediatric patients. Perioper Med (Lond) 2022; 11:35. [PMID: 35989325 PMCID: PMC9394006 DOI: 10.1186/s13741-022-00269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pentraxins are inflammatory proteins and markers of acute-phase responses. They are divided into short and long subgroups based on the length of the N-terminal region. The most studied short pentraxin is the C-reactive protein (CRP), which is known to be expressed in various inflammatory conditions, including surgical procedures. On the other hand, much less is known about the kinetics of long pentraxin 3 (PTX3) in surgical patients, especially in the pediatric population.
The aim of this prospective study was to determine the early postoperative kinetics of PTX3 in relation to procalcitonin (PCT) and CRP levels in children undergoing congenital heart surgery with cardiopulmonary bypass (CPB).
Methods
A total of 21 children (9 boys and 12 girls, mean age 12 months) were included in the study. Blood samples for determination of CRP, PCT, and PTX3 levels were collected before the surgery and then immediately after its completion (postoperative day 0, POD 0) and subsequently at POD 1, 2, and 3.
Results
Serum PTX3 concentrations increased significantly between POD 0 and POD 1 (mean values were 12.2 and 72.4 ng/ml, respectively, p<0.001), decreased between POD 1 and POD 2 (mean values were 72.4 and 23.6 ng/ml, respectively, p<0.001), and normalized on POD 3 (the mean value was 1.2 ng/ml).
Conclusions
PTX3 concentrations are markedly elevated during the first postoperative day. Under normal circumstances, PTX3 rises and falls quickly, and its second rise in the early postoperative period may be abnormal, however, further studies are necessary.
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Peri-Operative Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Cardiac and Thoracic Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11050554. [PMID: 35625198 PMCID: PMC9137830 DOI: 10.3390/antibiotics11050554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023] Open
Abstract
Surgical site infections (SSIs) represent a potential complication of surgical procedures, with a significant impact on mortality, morbidity, and healthcare costs. Patients undergoing cardiac surgery and thoracic surgery are often considered patients at high risk of developing SSIs. This consensus document aims to provide information on the management of peri-operative antibiotic prophylaxis for the pediatric and neonatal population undergoing cardiac and non-cardiac thoracic surgery. The following scenarios were considered: (1) cardiac surgery for the correction of congenital heart disease and/or valve surgery; (2) cardiac catheterization without the placement of prosthetic material; (3) cardiac catheterization with the placement of prosthetic material; (4) implantable cardiac defibrillator or epicardial pacemaker placement; (5) patients undergoing ExtraCorporal Membrane Oxygenation; (6) cardiac tumors and heart transplantation; (7) non-cardiac thoracic surgery with thoracotomy; (8) non-cardiac thoracic surgery using video-assisted thoracoscopy; (9) elective chest drain placement in the pediatric patient; (10) elective chest drain placement in the newborn; (11) thoracic drain placement in the trauma setting. This consensus provides clear and shared indications, representing the most complete and up-to-date collection of practice recommendations in pediatric cardiac and thoracic surgery, in order to guide physicians in the management of the patient, standardizing approaches and avoiding the abuse and misuse of antibiotics.
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Suna J, Moloney G, Marathe SP, Bierbach B, Roberts JA, Parker S, Ungerer JPJ, Mcwhinney B, Dorofaeff T, Venugopal P, Alphonso N. Perioperative cefazolin prophylaxis in paediatric cardiac surgery: a prospective, cohort study. Ann Thorac Surg 2022; 114:1434-1440. [PMID: 35292260 DOI: 10.1016/j.athoracsur.2022.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study's objective was to determine the effect of age, prolonged bypass, and hypothermia on serum cefazolin concentrations in children undergoing cardiac surgery. METHODS A prospective, single-centre, observational study was conducted. Children undergoing cardiac surgery were examined. Participants received cefazolin intravenously approximately 1 hour before skin incision, 3 hourly intraoperatively and 8 hourly postoperatively. Blood samples were collected at 6-8 timepoints intraoperatively and 6-time points in the first 24 hours postoperatively. Target unbound serum cefazolin concentrations were of 2 mg/L. RESULTS Sixty-eight patients were enrolled in the study, and 64 included in the analysis. All maintained concentrations ≥ 2 mg/L throughout the operation. Nineteen patients (30%) did not maintain concentrations ≥ 2 mg/L in the first 24 hours following surgery. Older, larger children (p < 0.0001) were significantly less likely to achieve target unbound serum cefazolin concentrations. CONCLUSIONS Intraoperative cefazolin concentrations reached the target concentration in all paediatric cardiac surgical cases. Postoperative cefazolin dosing appears insufficient to achieve minimum inhibitory concentrations in many patients.
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Affiliation(s)
- Jessica Suna
- Industry Fellow, University of Queensland, Brisbane, Australia; Deputy Director, Queensland Paediatric Cardiac Research, Queensland Children's Hospital, Brisbane, Australia.
| | - Gregory Moloney
- Senior Medical Officer, Department of Anaesthetics, Queensland Children's Hospital, Brisbane, Australia
| | - Supreet P Marathe
- Lecturer, University of Queensland Clinical School, Queensland Children's Hospital, University of Queensland, Brisbane, Australia; Senior Cardiac Surgery Fellow, Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Australia
| | - Benjamin Bierbach
- Department of Paediatric Cardiac Surgery, University Hospital Bonn, Germany
| | - Jason A Roberts
- NHMRC Practitioner Fellow, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Consultant Pharmacist, Pharmacy Department and Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; Scientific Consultant, Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes France
| | - Suzanne Parker
- NHMRC Early Career Research Fellow, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Jacobus P J Ungerer
- Director Chemical Pathology, Pathology Queensland, Queensland Health, Brisbane Australia; School of Biomedical Sciences, University of Queensland, Brisbane Australia
| | - Brett Mcwhinney
- Supervising Scientist, Pathology Queensland, Queensland Health, Brisbane Australia
| | - Tavey Dorofaeff
- Senior Lecturer, University of Queensland Clinical School Queensland Children's Hospital, University of Queensland, Brisbane, Australia; Senior Medical Officer, Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Australia
| | - Prem Venugopal
- Senior Lecturer, University of Queensland Clinical School Queensland Children's Hospital, University of Queensland, Brisbane, Australia; Director of Cardiac Surgery, Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Australia
| | - Nelson Alphonso
- Associate Professor, Child Health Research Centre, University of Queensland, Brisbane, Australia; Deputy Director of Cardiac Surgery, Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Australia
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Suna J, Alphonso N. Cefazolin prophylaxis in children undergoing cardiac surgery-is it too little too late? Eur J Cardiothorac Surg 2021; 61:34-35. [PMID: 34269388 DOI: 10.1093/ejcts/ezab327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jessica Suna
- Children's Centre for Health Research, University of Queensland, Brisbane, Australia.,Queensland Paediatric Cardiac Research, Queensland Children's Hospital, Brisbane, Australia.,Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Australia
| | - Nelson Alphonso
- Children's Centre for Health Research, University of Queensland, Brisbane, Australia.,Queensland Paediatric Cardiac Research, Queensland Children's Hospital, Brisbane, Australia.,School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia.,Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Australia
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Ferrari F, Benegni S, Marinari E, Haiberger R, Garisto C, Rizza A, Giorni C, Quattrone MG, Arpicco S, Muntoni E, Milla P, Ricci Z. Vancomycin concentrations during cardiopulmonary bypass in pediatric cardiac surgery: a prospective study. Perfusion 2021; 37:553-561. [PMID: 33789546 DOI: 10.1177/02676591211006828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Few data are available regarding intraoperative plasma concentrations of vancomycin administered as prophylaxis in pediatric cardiac surgery. The aims of this study were to investigate during pediatric cardiac surgery with cardiopulmonary bypass(CPB) the attainment of the area-under-the-curve of the vancomycin serum concentrations versus time over surgery to minimum inhibitory concentration ratio(AUCintra/MIC) of 400 (mg × h)/l and/or a target concentration of 15-20 mg/l. METHODS In a prospective study, 40 patients divided into four subgroups (neonates, infants, children <10 years-old, ⩾10 years-old) undergoing cardiac surgery with cardiopulmonary bypass (CPB) were enrolled. A slow vancomycin bolus of 20 mg/kg, up to a maximum dose of 1000 mg was administered before skin incision and a further dose of 10 mg/kg (up to 500 mg) at CPB start. Vancomycin samples were collected intraoperatively at four time points. RESULTS The median (interquartile range) age was 241.5 days (47-3898) and the median weight was 7.1 kg (3.1-37). The median AUCintra/MIC was 254.73 (165.89-508.06). In 11 patients the AUCintra/MIC target was not reached. Neonates displayed the lowest AUCintra/MIC values, and these were significantly lower than those of children ⩾10 years old (p = 0.02). Vancomycin concentrations were above the maximal target of 20 mg/l in 82.5% and 80% of patients at surgery and CPB start, respectively. At CPB and surgery end, 42.5% of patients showed vancomycin concentrations above 20 mg/l and 42.5% below 15 mg/l. Patients⩾10 years old showed the highest peak values whereas neonates were those with the lowest troughs. AUCintra/MIC correlated with age(r:0.36, p = 0.02), weight(r:0.35, p = 0.03), intraoperative protein value(r:0.40, p = 0.01), CPB priming volume/kg(r:-0.33, p = 0.04), CPB duration(r:0.36, p = 0.02) and vancomycin troughs(r:0.35, p = 0.04). CONCLUSIONS An AUCintra/MIC ⩾400 target was not reached in one-quarter of children undergoing heart surgery. Vancomycin peaked before the start of surgery and neonates were those with the lowest troughs. Vancomycin concentrations are affected by CPB hemodilution and by patients' age and weight.
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Affiliation(s)
- Fiorenza Ferrari
- Intensive Care Unit, I.R.C.C.S. Fondazione Policlinico San Matteo, Pavia, Italy
| | - Simona Benegni
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eleonora Marinari
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roberta Haiberger
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristiana Garisto
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Rizza
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Giorni
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Silvia Arpicco
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Elisabetta Muntoni
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Paola Milla
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Zaccaria Ricci
- Azienda Ospedaliero Universitaria Meyer, Firenze, Italy.,Università di Firenze, Firenze, Italy
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Lapmahapaisan S, Maisat W, Tantiwongkosri K, Jutasompakorn P, Sisan W. Plasma concentrations of cefazolin in pediatric patients undergoing cardiac surgery. Ann Card Anaesth 2021; 24:149-154. [PMID: 33884969 PMCID: PMC8253018 DOI: 10.4103/aca.aca_106_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The guideline for antibiotic prophylaxis in pediatric cardiac surgery is currently unavailable, and the effects of cardiopulmonary bypass (CPB) may result in low plasma cefazolin concentrations and subsequent postoperative surgical site infections (SSIs). Aims To demonstrate the calculated-unbound plasma concentrations of cefazolin during uncomplicated pediatric cardiac surgery. Settings and Design A prospective observational study that included 18 patients <seven years of age, undergoing elective cardiac surgery with CPB. Materials and Methods An intravenous infusion of cefazolin (25 mg.kg-1) was administered to patients over 30 minutes within 1 hour before skin incision (first dose). Another 25 mg.kg-1 infusion was administered to the CPB prime volume (second dose). Blood samples were obtained at eight time points: 15 minutes after the first dose (T1); before aortic cannulation (T2); immediately after CPB initiation (T3); 30 (T4), 60 (T5), and 120 (T6) minutes after CPB; 15 minutes after CPB discontinuation (T7), and at skin closure (T8). The total plasma cefazolin concentrations were measured using liquid chromatography tandem mass spectrometry. Results The unbound cefazolin concentrations were calculated assuming 80%-protein binding. The median cefazolin levels were 18.1 (range 4.3-27.0), 11.9 (2.8-24.1), 31.4 (18.3-66.1), 23.4 (13.7-35.9), 20.2 (15.4-24.9), 17.7 (14.8-18.0), 15.6 (9.8-26.2), and 13.3 (8.3-24.6) μg.mL-1 from T1-T8, respectively. The cefazolin levels remained four times above the minimum inhibitory concentrations (MICs) for Methicillin-sensitive S. aureus (MSSA) and S. epidermidis in most patients, but they were inadequate for Enterobacter and E. coli. Conclusion This regimen produced adequate plasma cefazolin concentrations for common organisms that cause SSIs after cardiac surgery.
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Affiliation(s)
- Saowaphak Lapmahapaisan
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wiriya Maisat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kriangkrai Tantiwongkosri
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Pinpilai Jutasompakorn
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waraphorn Sisan
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Alahmadi YM, Alharbi RH, Aljabri AK, Alofi FS, Alshaalani OA, Alssdi BH. Adherence to the guidelines for surgical antimicrobial prophylaxis in a Saudi tertiary care hospital. J Taibah Univ Med Sci 2020; 15:136-141. [PMID: 32368210 PMCID: PMC7184216 DOI: 10.1016/j.jtumed.2020.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 12/16/2022] Open
Abstract
Objective The study evaluated the adherence to the guidelines for surgical antimicrobial prophylaxis in a Saudi tertiary care hospital. Methods The medical records of 707 patients from the surgical units over a selected 3-month period were selected. The data were reviewed and statistically analysed. Results Of the 707 respondents, 51.2% were women and most were older than 50 years. The most common surgical procedures involved orthopaedics (28.3%), followed by vascular surgery (15.1%). One hundred and thirty-eight (19.5%) patients received antibiotics according to the guidelines for surgical prophylaxis. More than half of the patients (399/56.4%) received antibiotics for more than 24 h and 129 (18.2%) received antibiotics for less than 24 h. Single dose antibiotic therapy was used in 179 (25.3%) patients. Two hundred and ninety-seven (42%) patients underwent clean surgery, 284 (40%) clean-contaminated and 128 (18%) contaminated surgery. A significant difference was evident between the antibiotics administered according to the recommended guidelines and the duration of antibiotic therapy (p = 0.001), duration (p = 0.001) and the type of surgical procedure (p = 0.00). Conclusion The findings of this study suggest that healthcare professionals do not strictly adhere to the guidelines for surgical antibiotic prophylaxis. Physicians are therefore encouraged to follow the recommendations appropriately and to regularly implement surgical antimicrobial prophylaxis for patient safety.
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Affiliation(s)
- Yaser M Alahmadi
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, Almadinah Almunawwarah, KSA
| | - Raed H Alharbi
- Pharmacy Department, Almadinah Almunawwarah General Hospital, Almadinah Almunawwarah, KSA
| | - Ahmad K Aljabri
- Clinical Pharmacy Services, King Fahad Hospital, Almadinah Almunawwarah, KSA
| | - Fadwa S Alofi
- Infectious Diseases Department, King Fahad Hospital, Almadinah Almunawwarah, KSA
| | - Omimah A Alshaalani
- Infectious Diseases Department, King Fahad Hospital, Almadinah Almunawwarah, KSA
| | - Baiaan H Alssdi
- Pharmacy Department, Almadinah Almunawwarah General Hospital, Almadinah Almunawwarah, KSA
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Ingrande J, Gutierrez K, Lemmens HJ, Verma A, Nicolau DP, Sutherland CA, Ramamoorthy C. Pharmacokinetics of Cefazolin and Vancomycin in Infants Undergoing Open-Heart Surgery With Cardiopulmonary Bypass. Anesth Analg 2020; 128:935-943. [PMID: 30995208 DOI: 10.1213/ane.0000000000003876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Gram-positive bacteria account for nearly three-quarters of all surgical site infections. Antibiotic prophylaxis against these bacteria with cephalosporins or, in select circumstances, with vancomycin is considered standard of care for prevention of surgical site infections. There is little evidence to describe the optimal dosing regimen for surgical site infection prophylaxis in infants undergoing cardiac surgery, and a great deal of institutional variability exists in dosing prophylactic antibiotics. We designed this study to describe an optimal dose regimen for cephalosporin and vancomycin based on pharmacokinetic evidence for infant open-heart surgery on cardiopulmonary bypass. METHODS Two separate cohorts of infants undergoing cardiac surgery with cardiopulmonary bypass were evaluated. Plasma concentrations of vancomycin (cohort 1, N = 10) and cefazolin (cohort 2, N = 10) were measured, and mixed-effects pharmacokinetic models were constructed for each drug. Simulations of various dosing regimens were performed to describe an appropriate dosing regimen necessary to maintain antibiotic concentrations above the susceptibility cutoff for staphylococci. RESULTS Both cefazolin and vancomycin plasma concentration versus time profiles were characterized by a 2-compartment model. Subject weight was a significant covariate for V1 for vancomycin. Subject age was a significant covariate for V1 for cefazolin. Cardiopulmonary bypass did not influence concentration versus time profiles. Simulations demonstrated that a 1-hour vancomycin infusion (15 mg·kg), repeated every 12 hours and a 10-minute infusion of cefazolin (30 mg·kg), repeated every 4 hours maintained plasma concentrations above 4 μg·mL and 16 μg·mL, for vancomycin and cefazolin, respectively. Both concentrations are above the minimum inhibitory concentration 90 for most susceptible staphylococci. CONCLUSIONS Prophylactic treatment of vancomycin 15 mg·kg infused >1 hour with 12-hour redosing and cefazolin 30 mg·kg infused >10 minutes with 4-hour redosing will maintain serum levels of each antibiotic above the susceptibility cut-offs for susceptible staphylococci in infants undergoing cardiac surgery. Cefazolin levels may be adequate for some, but not all, Gram-negative bacteria. The effect of cardiopulmonary bypass on pharmacokinetics is negligible.
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Affiliation(s)
- Jerry Ingrande
- From the Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, California
| | - Kathleen Gutierrez
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California
| | - Hendrikus J Lemmens
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Archana Verma
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
| | - Christina A Sutherland
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
| | - Chandra Ramamoorthy
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Cardiac Anesthesia, Stanford University School of Medicine, Stanford, California
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Jaworski R, Kansy A, Dzierzanowska-Fangrat K, Maruszewski B. Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review. Surg Infect (Larchmt) 2019; 20:253-260. [DOI: 10.1089/sur.2018.272] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Radoslaw Jaworski
- Department of Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Andrzej Kansy
- Department of Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | | | - Bohdan Maruszewski
- Department of Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
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Perioperative antibiotics in pediatric cardiac surgery: protocol for a systematic review. Syst Rev 2017; 6:107. [PMID: 28558846 PMCID: PMC5450342 DOI: 10.1186/s13643-017-0502-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/18/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Post-operative infections in pediatric cardiac surgery are an ongoing clinical challenge, with rates between 1 and 20%. Perioperative antibiotics remain the standard for prevention of surgical-site infections, but the type of antibiotic and duration of administration remain poorly defined. Current levels of practice variation through informal surveys are very high. Rates of antibiotic-resistant organisms are increasing steadily around the world. METHODS/DESIGN We will identify all controlled observational studies and randomized controlled trials examining prophylactic antibiotic use in pediatric cardiac surgery. Data sources will include MEDLINE, EMBASE, CENTRAL, and proceedings from recent relevant scientific meetings. For each included study, we will conduct duplicate independent data extraction, risk of bias assessment, and evaluation of quality of evidence using the GRADE approach. DISCUSSION We will report the results of this review in agreement with the PRISMA statement and disseminate our findings at relevant critical care and cardiology conferences and through publication in peer-reviewed journals. We will use this systematic review to inform clinical guidelines, which will be disseminated in a separate stand-alone publication. STUDY REGISTRATION NUMBER PROSPERO CRD42016052978C.
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Abstract
OBJECTIVES The objectives of this review are to discuss the prevalence and risk factors associated with the development of hospital-acquired infections in pediatric patients undergoing cardiac surgery and the published antimicrobial prophylaxis regimens and rational approaches to the diagnosis, prevention, and treatment of nosocomial infections in these patients. DATA SOURCE MEDLINE and PubMed. CONCLUSION Hospital-acquired infections remain a significant source of potentially preventable morbidity and mortality in pediatric cardiac surgical patients. Through improved understanding of these conditions and implementation of avoidance strategies, centers caring for these patients may improve outcomes in this vulnerable population.
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Kilbaugh TJ, Himebauch AS, Zaoutis T, Jobes D, Greeley WJ, Nicolson SC, Zuppa AF. A pilot and feasibility study of the plasma and tissue pharmacokinetics of cefazolin in an immature porcine model of pediatric cardiac surgery. Paediatr Anaesth 2015; 25:1111-9. [PMID: 26372607 DOI: 10.1111/pan.12756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical site infection (SSI) prevention for children with congenital heart disease is imperative and methods to assess and evaluate the tissue concentrations of prophylactic antibiotics are important to help maximize these efforts. AIM The purposes of this study were to determine the plasma and tissue concentrations with standard of care, perioperative cefazolin dosing in an immature porcine model of pediatric cardiac surgery, and to determine the feasibility of this model. METHODS Piglets (3-5 days old) underwent either median sternotomy (MS) or cardiopulmonary bypass with deep hypothermic circulatory arrest (CPB + DHCA) and received standard of care prophylactic cefazolin for the procedures. Serial plasma and microdialysis sampling of the skeletal muscle and subcutaneous tissue adjacent to the surgical site was performed. Cefazolin concentrations were measured, noncompartmental pharmacokinetic analyses were performed, and tissue penetration of cefazolin was assessed. RESULTS Following the first intravenous dose, maximal cefazolin concentrations in the subcutaneous tissue and skeletal muscle were similar between groups with peak tissue concentrations 15-30 min after administration. After the second cefazolin dose given with the initiation of CPB, total plasma cefazolin concentrations remained relatively constant until the end of DHCA and then decreased while muscle- and subcutaneous-unbound cefazolin concentrations showed a second peak during or after rewarming. For the MS group, 60-67% of the intraoperative time showed subcutaneous and skeletal muscle concentrations of cefazolin >16 μg·ml(-1) while this percentage was 78-79% for the CPB + DHCA group. There was less tissue penetration of cefazolin in the group that underwent CBP + DHCA (P = 0.03). CONCLUSIONS The cefazolin dosing used in this study achieves plasma and tissue concentrations that should be effective against methicillin-sensitive Staphylococcus aureus but may not be effective against some gram-negative pathogens. The timing of the cefazolin administration prior to incision and a second dose given during cardiopulmonary bypass may be important factors for achieving goal tissue concentrations.
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Affiliation(s)
- Todd J Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Pharmacology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Theoklis Zaoutis
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Infectious Diseases, The Children's Hospital of Philadelphia and The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - David Jobes
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - William J Greeley
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Susan C Nicolson
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Athena F Zuppa
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Pharmacology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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14
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Izquierdo-Blasco J, Campins-Martí M, Soler-Palacín P, Balcells J, Abella R, Gran F, Castillo F, Nuño R, Sanchez-de-Toledo J. Impact of the implementation of an interdisciplinary infection control program to prevent surgical wound infection in pediatric heart surgery. Eur J Pediatr 2015; 174:957-63. [PMID: 25652766 DOI: 10.1007/s00431-015-2493-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 01/11/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED Surgical site infection (SSI) remains a major source of morbidity, mortality, and increased health care costs in children undergoing heart surgery. The aim of this study was to assess the effectiveness of an intervention program designed to reduce the high incidence of SSI observed at our center in pediatric patients. An interdisciplinary infection control program including pre-, intra-, and postoperative measures was introduced for children undergoing heart surgery with cardiopulmonary bypass. We conducted a quasi-experimental interventional study comparing a pre-intervention cohort (June 2009 to March 2010) and a post-intervention cohort (July 2011 to July 2012). A significant drop in SSI incidence from 10.9 % (95 % CI 4.7-18.8) to 1.92 % (95 % CI 0.4-5.52) was observed. Variables significantly associated with infection risk were median age (14 days in infected vs 2.3 years in non-infected patients; p<0.01), hospitalization unit (10.3 % SSI cumulative incidence in the neonatal intensive care unit vs 0 cases in the pediatric intensive care unit; p<0.01), and median preoperative hospital stay (14 days in infected vs 1 day in non-infected patients; p=0.03). CONCLUSIONS The implementation of a new intervention program was associated with an 82 % (95 % CI 34-94) reduction in SSI incidence in children undergoing heart surgery at our center. WHAT IS KNOWN • Surgical site infection (SSI) is associated with significant morbidity and mortality following pediatric cardiac surgery. • Younger patients and longer cardiopulmonary bypass times are associated with higher SSI rates. What is New: • Comprehensive infection control program including preoperative, intraoperative and postoperative nonpharmacologic measures is a key factor for the prevention of SSI. • A significant reduction in SSI rates can be achieve despite a narrower-spectrum antibiotic usage.
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Affiliation(s)
- Jaume Izquierdo-Blasco
- Department of Pediatric Intensive Care Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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15
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Abstract
There are unique challenges to antimicrobial stewardship in neonatal intensive care units (NICUs). Diagnosis of infection is difficult as neonates can have nonspecific signs and symptoms. Between and within NICUs, significant variation exists in the treatment duration of suspected sepsis and pneumonia. Development of multidisciplinary teams and meaningful metrics are essential for sustainable antibiotic stewardship. Potential stewardship interventions include optimizing culturing techniques, guiding empiric therapy by NICU-specific antibiograms, using ancillary laboratory tests, and promptly discontinuing therapy once infection is no longer suspected. Use of large neonatal databases can be used to benchmark antibiotic use and conduct comparative effectiveness research.
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Affiliation(s)
- Joseph B Cantey
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Division of Neonatal/Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Sameer J Patel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 20, Chicago, Illinois 60611-2605, USA
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16
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Turcotte RF, Brozovich A, Corda R, Demmer RT, Biagas KV, Mangino D, Covington L, Ferris A, Thumm B, Bacha E, Smerling A, Saiman L. Health care-associated infections in children after cardiac surgery. Pediatr Cardiol 2014; 35:1448-55. [PMID: 24996642 DOI: 10.1007/s00246-014-0953-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 06/12/2014] [Indexed: 11/25/2022]
Abstract
Few recent studies have assessed the epidemiology of health care-associated infections (HAIs) in the pediatric population after cardiac surgery. A retrospective cohort study was performed to assess the epidemiology of several types of HAIs in children 18 years of age or younger undergoing cardiac surgery from July 2010 to June 2012. Potential pre-, intra-, and postoperative risk factors, including adherence to the perioperative antibiotic prophylaxis regimen at the authors' hospital, were assessed by multivariable analysis using Poisson regression models. Microorganisms associated with HAIs and their susceptibility patterns were described. Overall, 634 surgeries were performed, 38 (6 %) of which were complicated by an HAI occurring within 90 days after surgery. The HAIs included 7 central line-associated bloodstream infections (CLABSIs), 12 non-CLABSI bacteremias, 6 episodes of early postoperative infective endocarditis (IE), 9 surgical-site infections (SSIs), and 4 ventilator-associated pneumonias (VAPs). Mechanical ventilation (rate ratio [RR] 1.07 per day; 95 % confidence interval [CI] 1.03-1.11; p = 0.0002), postoperative transfusion of blood products (RR 3.12; 95 %, CI 1.38-7.06; p = 0.0062), postoperative steroid use (RR 3.32; 95 % CI 1.56-7.02; p = 0.0018), and continuation of antibiotic prophylaxis longer than 48 h after surgery (RR 2.56; 95 % CI 1.31-5.03; p = 0.0062) were associated with HAIs. Overall, 66.7 % of the pathogens associated with SSIs were susceptible to cefazolin, the perioperative antibiotic prophylaxis used by the authors' hospital. In conclusion, HAIs occurred after 6 % of cardiac surgeries. Bacteremia and CLABSI were the most common. This study identified several potentially modifiable risk factors that suggest interventions. Further studies should assess the role of improving adherence to perioperative antibiotic prophylaxis, the age of transfused red blood cells, and evidence-based guidelines for postoperative steroids.
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Affiliation(s)
- Rebecca F Turcotte
- Department of Pediatrics, Columbia University Medical Center, 3959 Broadway, CHN 10-24, New York, NY, 10032, USA,
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17
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Murray MT, Corda R, Turcotte R, Bacha E, Saiman L, Krishnamurthy G. Implementing a standardized perioperative antibiotic prophylaxis protocol for neonates undergoing cardiac surgery. Ann Thorac Surg 2014; 98:927-33. [PMID: 25038006 DOI: 10.1016/j.athoracsur.2014.04.090] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/11/2014] [Accepted: 04/21/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND A lack of perioperative antibiotic prophylaxis guidelines for neonates undergoing cardiac surgery has resulted in a wide variation in practice. We sought to do the following: (1) Determine the safety of a perioperative antibiotic prophylaxis protocol for neonatal cardiac surgery as measured by surgical site infections (SSIs) rates before and after implementation of the protocol; and (2) evaluate compliance with selected process measures for perioperative antibiotic prophylaxis. METHODS This quasi-experimental study included all cardiac procedures performed on neonates from July 2009 to June 2012 at a single center. An interdisciplinary task force developed a standardized perioperative antibiotic prophylaxis protocol in the fourth quarter of 2010. The SSI rates were compared in the preintervention (July 2009 to December 2010) versus the postintervention periods (January 2011 to June 2012). Compliance with process measures (appropriate drug, dose, timing, and discontinuation of perioperative antibiotic prophylaxis) was compared in the 2 periods. RESULTS During the study period, 283 cardiac procedures were performed. The SSI rates were similar in the preintervention and postintervention periods (6.21 vs 5.80 per 100 procedures, respectively). Compliance with the 4 process measures significantly improved postintervention. CONCLUSIONS Restricting the duration of perioperative antibiotic prophylaxis after neonatal cardiac surgery to 48 hours in neonates with a closed sternum and to 24 hours after sternal closure was safe and did not increase the rate of SSIs. Compliance with selected process measures improved in the postintervention period. Additional multicenter studies are needed to develop national guidelines for perioperative prophylaxis for this population.
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Affiliation(s)
- Meghan T Murray
- School of Nursing, Columbia University Medical Center, New York, New York
| | - Rozelle Corda
- School of Nursing, Columbia University Medical Center, New York, New York; Department of Surgery, Columbia University Medical Center, New York, New York
| | - Rebecca Turcotte
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Emile Bacha
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Medical Center, New York, New York; Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York
| | - Ganga Krishnamurthy
- Department of Pediatrics, Columbia University Medical Center, New York, New York.
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18
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Antibioprophylaxie peropératoire pour la chirurgie viscérale et urologique en pédiatrie. Arch Pediatr 2013; 20 Suppl 3:S67-73. [DOI: 10.1016/s0929-693x(13)71410-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 690] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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20
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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21
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[Antibiotic prophylaxis for surgical wound infection in cardiac surgery: results of a Spanish survey]. An Pediatr (Barc) 2013; 79:26-31. [PMID: 23291524 DOI: 10.1016/j.anpedi.2012.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 11/19/2012] [Accepted: 11/20/2012] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION No Spanish guidelines for the prevention of surgical wound infection in paediatric cardiac surgery are currently available. The aim of this study was to analyse the nationwide variability in antibiotic prophylaxis use. MATERIAL AND METHODS An online questionnaire was distributed to all members of the Cardiology Group of the Spanish Society of Paediatric Intensive Care. Fifteen centres participated in the study. RESULTS In heart surgery with no delayed sternal closure, all 15 centres used a 1st or 2nd generation cephalosporin in paediatric patients, while 3 hospitals used a broader-spectrum antibiotic therapy in neonates. Prophylaxis was maintained for 12-72h in 11 centres and until drainage removal in four. Thirteen centres used delayed sternal closure, eight of which followed the same protocol for these patients as for standard procedures. Prophylaxis was maintained for 12-72h in 6 centres, and until sternal closure at the rest. Five out of 10 centres performing extracorporeal membrane oxygenation (ECMO) maintained the same antibiotic protocol as in standard surgery. CONCLUSIONS A wide variability was observed in antibiotic prophylaxis use in high-risk patients. Thus, national protocols need to be standardised.
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22
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Abstract
The judicious use of antibiotics is an important means to limit the emergence of antibiotic-resistant organisms. Although specific guidelines for neonates are often lacking, antibiotic stewardship principles can be applied to the neonatal intensive care unit. Principles include accurately identifying patients who need antibiotic therapy, using local epidemiology to guide the selection of empiric therapy, avoiding agents with overlapping activity, adjusting antibiotics when culture results become available, monitoring for toxicity, and optimizing the dose, route, and duration of therapy. Neonatal intensive care units should develop interdisciplinary antimicrobial stewardship teams with the support of their institutions. Prescriber audit and feedback, as well as preauthorization and formulary restriction of selected antibiotics, are recommended antimicrobial stewardship interventions. Ancillary strategies include education and computerized decision support. Metrics to evaluate antimicrobial stewardship programs should include measurements of patient safety and quality, such as rates of adverse drug events, and appropriate dosing and timing of perioperative prophylaxis.
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Affiliation(s)
- Sameer J. Patel
- Assistant Professor of Pediatrics, Department of Pediatrics, Columbia University, New York, NY
| | - Lisa Saiman
- Professor of Clinical Pediatrics, Department of Pediatrics, Columbia University, New York, NY
- Hospital Epidemiologist, Department of Infection Prevention & Control, Morgan Stanley Children’s Hospital of New York-Presbyterian, New York, NYFrom: Children’s Hospital of New York-Presbyterian
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23
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Vogt W, Läer S. Prevention for pediatric low cardiac output syndrome: results from the European survey EuLoCOS-Paed. Paediatr Anaesth 2011; 21:1176-84. [PMID: 21851475 DOI: 10.1111/j.1460-9592.2011.03683.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Characterize current hospital practices related to preventive drug therapy for low cardiac output syndrome (LCOS) in children with open heart surgery (OHS) in Europe. METHODS Web-based questionnaire survey of European hospitals performing OHS in children, conducted between January and August 2009. RESULTS Responses to the questionnaire were obtained from 90 of 125 hospitals (72.0%) from 31 different countries across the geographical European regions. The majority of hospitals (77.8%) administered preventive drug therapy and primarily targeted patients at risk (63.3%). Twenty-four different drug regimens were reported, involving 17 drugs from seven therapeutic drug classes. Milrinone, dopamine, epinephrine, dobutamine, and levosimendan made up 85.9% of the total drug use. Furthermore, milrinone was reported in 70.7% of all drug regimens and significantly more often in combination with other drugs than monotherapy (Δ20%, 95% CI 4.7-34.1%). Milrinone combination therapy reports included lower bolus but higher maintenance infusion doses than monotherapy reports. The timing of drug regimen administration varied across the full perioperative period, but drug regimens were mostly initiated during surgery and continued postoperatively. CONCLUSION Although current hospital practices related to preventive drug therapy for LCOS in children with OHS are characterized by a marked variability, only few drugs make up the bulk of prescribing practice with milrinone being most commonly used. Therefore, the survey provides information on which drugs to focus research and establish safe and effective drug use. A unified approach is urgently needed to ensure that children with OHS can benefit from evidence-based care.
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Affiliation(s)
- Winnie Vogt
- Department of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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24
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Knoderer CA, Cox EG, Berg MD, Webster AH, Turrentine MW. Efficacy of limited cefuroxime prophylaxis in pediatric patients after cardiovascular surgery. Am J Health Syst Pharm 2011; 68:909-14. [DOI: 10.2146/ajhp100563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Elaine G. Cox
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, and Clinical Pharmacist, Department of Pharmacy, Riley Hospital for Children, Clarian Health, Indianapolis
| | - Michelle D. Berg
- Ryan White Center for Pediatric Infectious Disease, Indiana University School of Medicine, Indianapolis
| | - Andrea H. Webster
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University
| | - Mark W. Turrentine
- Department of Surgery, Section of Cardiothoracic Surgery, Indiana University School of Medicine
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25
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Hasija S, Makhija N, Kiran U, Choudhary SK, Talwar S, Kapil A. Nosocomial infections in infants and children after cardiac surgery. Indian J Thorac Cardiovasc Surg 2009. [DOI: 10.1007/s12055-008-0052-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
A large number of patients in developing countries require surgical correction of congenitally malformed hearts. Unfortunately, only a limited number of centres offer these patients surgery at an affordable cost. In this review, we discuss the problems in managing these patients, with an emphasis on reduction of costs, so that the maximum number of patients can benefit. It is apparent that containing costs requires a multipronged approach, which begins with timely referral, and continues with early surgical correction and adequate postoperative care carried out in a scientific manner. Indigenization, innovation, training of manpower, and building a team, are essential to cut the costs, and to improve the quality of care.
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27
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Current World Literature. Curr Opin Anaesthesiol 2008; 21:85-8. [DOI: 10.1097/aco.0b013e3282f5415f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Peri-operative antibiotic prophylaxis in paediatric cardiac surgery. Cardiol Young 2007; 17:695; author reply 696. [PMID: 18265448 DOI: 10.1017/s1047951107001497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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