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Elnour AA, Al-Khidir IY, Elkheir H, Elkhawad A, O AAM, A AKK, Nahar G, Alrwili SF, Alshelaly DA, Saleh A, Aljaber LK, Alrashedi AA. Double blind randomized controlled trial for subjects undergoing surgery receiving surgical antimicrobial prophylaxis at tertiary hospital: the clinical pharmacist's interventions. Pharm Pract (Granada) 2022; 20:2727. [PMID: 36793909 PMCID: PMC9891789 DOI: 10.18549/pharmpract.2022.4.2727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background A surgical site infection (SSI) has significant clinical, humanistic and economic consequences. Surgical antimicrobials prophylaxis (SAP) is a reliable standard to prevent SSIs. Objective The objective was to test that the clinical pharmacist's interventions may facilitate the implementation of SAP protocol and subsequent reduction of SSIs. Methods This was double blinded randomized controlled interventional hospital-based-study at Khartoum State-Sudan. A total of 226 subjects underwent general surgeries at four surgical units. Subjects were randomized to interventions and controls in a (1:1) ratio where patient, assessors and physician were blinded. The surgical team has received structured educational and behavioral SAP protocol mini courses by way of directed lecturers, workshops, seminars and awareness campaigns delivered by the clinical pharmacist. The clinical pharmacist provided SAP protocol to the interventions group. The outcome measure was the primary reduction in SSIs. Results There were (51.8%, 117/226) females, (61/113 interventions versus 56/113 controls), and (48.2%, 109/226) males (52 interventions and 57 controls). The overall rate of SSIs was assessed during 14 days post-operatively and was documented in (35.4%, 80/226). The difference in adherence to locally developed SAP protocol regarding the recommended antimicrobial was significant (P <0.001) between the interventions group (78, 69%) and the controls group (59, 52.2%). The clinical pharmacist's implementation of the SAP protocol revealed significant differences in SSIs with reduction in SSIs from 42.5% to 25.7% versus the controls group from 57.5% to 44.2% respectively, P = 0.001 between the interventions group and the controls group respectively. Conclusion The clinical pharmacist's interventions were very effective in sustainable adherence to SAP protocol and subsequent reduction in SSIs within the interventions group.
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Affiliation(s)
- Asim Ahmed Elnour
- PhD, MSc. Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates. AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates.
| | - Israa Y Al-Khidir
- PhD. Assistant Professor, Clinical Pharmacist, University of Hail (UOH), Hail - King Saudia Arabia (KSA).
| | - Habab Elkheir
- Department of Pharmacology, Faculty of Pharmacy, (PhD, MSc, B Pharm), Assistant Professor, Omdurman Islamic University, Khartoum, Sudan.
| | - Abdalla Elkhawad
- Department of Pharmacology, Faculty of Pharmacy, Professor, University of Medical Sciences Technology-UMST, Khartoum, Sudan.
| | - Ahmed A Mohammed O
- Assistant Professor (MBBS, MHPE, MD), Faculty of Public Health and Health Informatics, Umm Al-Qura University, King Saudi Arabia (KSA).
| | - Al-Kubaissi Khalid A
- PhD, MSc. Department of Pharmacy Practice & Pharmacotherapeutics, College of Pharmacy-University of Sharjah, Sharjah-United Arab Emirates.
| | - Ghadah Nahar
- Student, College of Pharmacy, University of Hail (UOH), Hail - Kingdom Saudia Arabia (KSA).
| | - Shahad Fayad Alrwili
- Student, College of Pharmacy, University of Hail (UOH), Hail -kingdom Saudia Arabia (KSA).
| | - Donia Ahmed Alshelaly
- Student, College of Pharmacy, University of Hail (UOH), Hail - Kingdom Saudia Arabia (KSA).
| | - Amjad Saleh
- Student, College of Pharmacy, University of Hail (UOH), Hail - Kingdom Saudia Arabia (KSA).
| | - Latefa Khulif Aljaber
- Student, College of Pharmacy, University of Hail (UOH), Hail - kingdom Saudi Arabia (KSA).
| | - Abrar Ayad Alrashedi
- Student, College of Pharmacy, University of Hail (UOH), Hail - Kingdom Saudia Arabia (KSA).
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Khan F, Chaudhary B, Sultan A, Ahmad M, Alvi Y, Shah MS, Khan HM. Qualitative Thematic Analysis of Knowledge and Practices of Surgical Antimicrobial Prophylaxis at a Tertiary Care Teaching Hospital. Surg Infect (Larchmt) 2020; 22:434-441. [PMID: 33944586 DOI: 10.1089/sur.2020.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Surgical antimicrobial prophylaxis (SAP) refers to the utilization of antibiotic agents for the prevention of surgical site infections (SSI), to prevent SSI-associated morbidity and mortality, reduce duration and cost of healthcare, and cause minimal adverse drug effects. The adherence rate among surgeons for the available international and national guidelines and optimal practice remains considerably low in many hospitals, especially in developing countries. The objective of this study was to assess the knowledge and compliance rate for SAP guidelines among various surgical specialties and those involved in providing SAP. Methods: An institution-based exploratory, multi-specialty, collective, mixed method approach (qualitative and quantitative) was used to assess the knowledge and compliance rate for SAP guidelines among the consultants and residents of surgical specialties. Quantitative analysis was performed using a pre-tested questionnaire. For qualitative analysis, focus group discussions were conducted. Thematic analysis was conducted by the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities, Motivation and Behaviour (COM-B) model. Results: Twenty-eight focus groups and 16 paired interviews were undertaken. On thematic analysis six significant themes were noted and mapped to the COM-B model, and subthemes mapped to the relevant TDF domains in a combined framework. Key themes recognized were: (1) solitary focus on surgical skills; (2) following the hierarchy is more important than guideline compliance; (3) doubts and overcautious attitude of surgeons hinders appropriate SAP prescribing; (4) non-availability in-hospital supply of antimicrobial agents; (5) patient characteristics and type of surgery play a role in prescribing SAP; and (6) lack of national and local guidelines. Conclusions: The knowledge and attitudes of surgeons toward appropriate SAP prescribing are crucial factors for execution of guidelines. Including them in policy making decisions can help in strong execution of the same.
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Affiliation(s)
- Fatima Khan
- Department of Microbiology, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Bhanu Chaudhary
- 7th Semester, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Asfia Sultan
- Department of Microbiology, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Manzoor Ahmad
- Department of Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Yasir Alvi
- Department of Community Medicine, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Mohammad Salman Shah
- Department of Community Medicine, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
| | - Haris M Khan
- Department of Microbiology, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
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García Posada MJ, Mora Solano E, Maza A, Hoyos JH. Infecciones del sitio operatorio posterior a mastectomía radical modificada, análisis epidemiológico en una clínica oncológica. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La tasa de incidencia de infecciones del sitio operatorio asociadas a cirugías mamarias varía desde el 6 hasta el 38 %. Se presentan la incidencia local y el perfil microbiológico de las infecciones en una clínica oncológica.
Métodos. Se trata de un estudio de cohorte, prospectivo, descriptivo, durante un periodo de un año en el Instituto Médico de Alta Tecnología, IMAT Oncomédica, de mujeres con diagnóstico de cáncer de mama, que presentaron infecciones del sitio operatorio después de la mastectomía.
Resultados. Se encontraron 335 cirugías registradas y la incidencia de infecciones del sitio operatorio fue del 3,38 %, todas en mastectomías radicales con reconstrucción. Se obtuvo crecimiento bacteriano en el 77 % de los cultivos, principalmente de cocos Gram positivos, con predominio de Staphylococcus aureus sensible a la meticilina (SAMS). Los bacilos Gram negativos representaron el 40 %. Se administraron cefalosporinas de primera generación como profilaxis antibiótica prequirúrgica, la cual fue correcta en el 31 % de los casos. En el 50 % de las pacientes infectadas se practicó el baño prequirúrgico y se cumplió el protocolo institucional.
Conclusiones. La incidencia encontrada de infecciones del sitio operatorio es menor que la reportada en otras series. Staphylococcus aureus sensible a la meticilina fue el microorganismo responsable más frecuente. El cumplimiento de la profilaxis con cefalosporina y baño prequirúrgico es fundamental para disminuir la incidencia de infecciones del sitio operatorio.
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Targeted Multidrug Resistant Organism Antimicrobial Prophylaxis and Postoperative Infections in Pediatric Cardiothoracic Surgical Patients. Pediatr Infect Dis J 2020; 39:514-518. [PMID: 32084113 DOI: 10.1097/inf.0000000000002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To determine if receiving targeted antimicrobial (AM) prophylaxis has an effect on the rate of postoperative infections in patient's colonized with a multidrug resistant organism (MDRO) undergoing cardiothoracic surgery (CTS). METHODS Single-center, retrospective medical record review of pediatric patients from birth to 18 years of age undergoing CTS from January 2013 to September 2018. Demographic data collected included age, specific MDRO, site of MDRO colonization, type of surgery, perioperative AM agent and type of infection. Patients were stratified into 2 groups, MDRO+ and MDRO-. Demographic and clinical characteristics were compared between groups with a Student's t test for continuous variables and a χ2, Fisher exact test or Mann-Whitney U test for noncontinuous variables. A 2-sided significance level of α = 0.05 was used to determine statistical significance. All analyses were performed using IBM SPSS Version 24 (SPSS Inc., Chicago, IL). RESULTS Fifty patients (26 males/24 females) were included in the MDRO (+) group and 295 patients (168 males/127 females) in the MDRO (-) group. The median age was 0.48 years (interquartile range 0.24-1 year) and 0.9 years (interquartile range 0.19-8 years) in the MDRO (+) and MDRO (-) groups, P = 0.003. 2 of 50 (4%) MDRO (+) patients and 15 of 295 (5.1 %) MDRO (-) patients developed an infection, P = 1. 10 of 50 (20%) MDRO (+) patients received targeted AM toward the MDRO and none developed an infection. Of the 2 MDRO (+) patients with infection, 1 was infected with the MDRO. For MDRO (+) patients, there was no difference in the rate of infection whether targeted AM therapy was received, P = 1. CONCLUSIONS There was no difference in the rate of postoperative infection between MDRO (+) and MDRO (-) patients. Additionally, these preliminary pediatric data suggest targeting AM agents to a specific MDRO does not impact the rate of postoperative infection in children undergoing CTS. Larger studies are warranted to confirm these findings.
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Inappropriate antibiotic surgical prophylaxis in pediatric patients: A national point-prevalence study. Infect Control Hosp Epidemiol 2020; 41:477-479. [PMID: 32127068 DOI: 10.1017/ice.2020.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Extended Versus Narrow-spectrum Antibiotics in the Management of Uncomplicated Appendicitis in Children: A Propensity-matched Comparative Effectiveness Study. Ann Surg 2019; 268:186-192. [PMID: 28654543 DOI: 10.1097/sla.0000000000002349] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of extended versus narrow spectrum antibiotics in preventing surgical site infections (SSIs) and hospital revisits in children with uncomplicated appendicitis. SUMMARY OF BACKGROUND DATA There is a paucity of high-quality evidence in the pediatric literature comparing the effectiveness of extended versus narrow-spectrum antibiotics in the prevention of SSIs associated with uncomplicated appendicitis. METHODS Clinical data from the ACS NSQIP-Pediatric Appendectomy Pilot Project were merged with antibiotic utilization data from the Pediatric Health Information System database for patients undergoing appendectomy for uncomplicated appendicitis at 17 hospitals from January 1, 2013 to June 30, 2015. Patients who received piperacillin/tazobactam (extended spectrum) were compared with those who received either cefoxitin or ceftriaxone with metronidazole (narrow spectrum) after propensity matching on demographic and severity characteristics. Study outcomes were 30-day SSI and hospital revisit rates. RESULTS Of the 1389 patients included, 39.1% received piperacillin/tazobactam (range by hospital: 0% to 100%), and the remainder received narrow-spectrum agents. No differences in demographics or severity characteristics were found between groups following matching. In the matched analysis, the rates of SSI were similar between groups [extended spectrum: 2.4% vs narrow spectrum 1.8% (odds ratio, OR: 1.05, 95% confidence interval, 95% CI 0.34-3.26)], as was the rate of revisits [extended spectrum: 7.9% vs narrow spectrum 5.1% (OR: 1.46, 95% CI 0.75-2.87)]. CONCLUSIONS Use of extended-spectrum antibiotics was not associated with lower rates of SSI or hospital revisits when compared with narrow-spectrum antibiotics in children with uncomplicated appendicitis. Our results challenge the routine use of extended-spectrum antibiotics observed at many hospitals, particularly given the increasing incidence of antibiotic-resistant organisms.
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Mahmoudi L, Ghouchani M, Mahi-Birjand M, Bananzadeh A, Akbari A. Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact. Infect Drug Resist 2019; 12:2437-2444. [PMID: 31496756 PMCID: PMC6689569 DOI: 10.2147/idr.s212728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Antibiotic prophylaxis is one of the major approaches to prevent surgical site infection. Despite the availability of international guidelines on it, the practice of antibiotic prophylaxis is still far from optimal. This study aimed to assess the impact of guideline implementation on the rational use of prophylactic antibiotics and its cost-saving effect in gastrointestinal surgery by clinical pharmacist intervention. METHODS A pre and post intervention study was carried out between October 2017 and June 2018 on patients who underwent gastrointestinal surgery in a major referral teaching hospital in Shiraz, southern Iran. The intervention phase consisted of revising the institutional guidelines for surgical antimicrobial prophylaxis, assigning a clinical pharmacist to the surgical department, and arranging several meetings with the surgical department regarding the appropriate utilization of antibiotics. Differences in antibiotic utilization in patients before and after the intervention phase were compared. Exposures were surgical antimicrobial prophylaxis timing and agents, and main outcomes were incidence of surgical site infection and length of hospital stay. RESULTS A total of 430 patients were included in the post intervention phase, while 445 patients were included in the baseline evaluation. Promoting appropriate antibiotic use in the post intervention group had the potential to decrease medication costs by reducing unnecessary prescriptions and duration of antibiotic usage (P<0.001). In the pre intervention group, the mean cost of antibiotic prescriptions was 11.5 times that of the post intervention group. Mean hospitalization in the pre intervention group was greater than the post intervention group (P<0.001). Furthermore, our data revealed that the rate of postsurgery infection in the post intervention group was 3.03%, while this rate was 6.76% in the preintervention group (P=0.01). CONCLUSION This study provides evidence that adherence to surgical antimicrobial prophylaxis guidelines increased the rational use of prophylactic antibiotics, with substantial cost savings in patients who underwent surgery.
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Affiliation(s)
- Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Ghouchani
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Motahareh Mahi-Birjand
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Ali Akbari
- Department of Anesthesiology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Micallef C, Chaudhry NT, Holmes AH, Hopkins S, Benn J, Franklin BD. Secondary use of data from hospital electronic prescribing and pharmacy systems to support the quality and safety of antimicrobial use: a systematic review. J Antimicrob Chemother 2018; 72:1880-1885. [PMID: 28369528 DOI: 10.1093/jac/dkx082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/21/2017] [Indexed: 11/13/2022] Open
Abstract
Background Electronic prescribing (EP) and electronic hospital pharmacy (EHP) systems are increasingly common. A potential benefit is the extensive data in these systems that could be used to support antimicrobial stewardship, but there is little information on how such data are currently used to support the quality and safety of antimicrobial use. Objectives To summarize the literature on secondary use of data (SuD) from EP and EHP systems to support quality and safety of antimicrobial use, to describe any barriers to secondary use and to make recommendations for future work in this field. Methods We conducted a systematic search within four databases; we included original research studies that were (1) based on SuD from hospital EP or EHP systems and (2) reported outcomes relating to quality and/or safety of antimicrobial use and/or qualitative findings relating to SuD in this context. Results Ninety-four full-text articles were obtained; 14 met our inclusion criteria. Only two described interventions based on SuD; seven described SuD to evaluate other antimicrobial stewardship interventions and five described descriptive or exploratory studies of potential applications of SuD. Types of data used were quantitative antibiotic usage data ( n = 9 studies), dose administration data ( n = 4) and user log data from an electronic dashboard ( n = 1). Barriers included data access, data accuracy and completeness, and complexity when using data from multiple systems or hospital sites. Conclusions The literature suggests that SuD from EP and EHP systems is potentially useful to support or evaluate antimicrobial stewardship activities; greater system functionality would help to realize these benefits.
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Affiliation(s)
- Christianne Micallef
- NIHR Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK.,Pharmacy Department, Addenbrooke`s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Navila T Chaudhry
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Alison H Holmes
- NIHR Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK.,Department of Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - Susan Hopkins
- NIHR Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK.,Public Health England, London, UK
| | - Jonathan Benn
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Bryony Dean Franklin
- NIHR Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK.,Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.,Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, UK
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9
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Litz CN, Asuncion JB, Danielson PD, Chandler NM. Timing of antimicrobial prophylaxis and infectious complications in pediatric patients undergoing appendectomy. J Pediatr Surg 2018; 53:449-451. [PMID: 28528712 DOI: 10.1016/j.jpedsurg.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Antibiotic administration within one hour prior to incision is a common quality metric; however, antibiotics are typically started at the time of diagnosis in pediatric patients with acute appendicitis. The purpose was to determine if antibiotic administration within one hour prior to incision reduces the incidence of surgical site infections (SSI) in pediatric patients with acute appendicitis started on parenteral antibiotics upon diagnosis. METHODS A retrospective review was performed of 478 patients aged 0-18years who underwent appendectomy for acute appendicitis from 7/2013 to 4/2015. Patients were categorized based on timing of antibiotic administration; there were 198 patients in Group A (<60min before) and 280 in Group B (>60min before). RESULTS Demographics and operative time (A: 30.5±9.9 vs B: 30.8±12.2min, p=0.51) were similar. Procedures were performed laparoscopically and the groups had similar proportions of single-incision operations (A: 53% vs B: 55%, p=0.64). There was no difference in the incidence of superficial SSI (A: 2.0% vs B: 2.1%, p=1.0) or intraabdominal abscess (A: 4.0% vs B: 3.6%, p=0.81) and this remained true when stratified by intraoperative classification. CONCLUSION Antibiotic administration within one hour of appendectomy in pediatric patients with acute appendicitis who receive antibiotics at diagnosis did not change the incidence of postoperative infectious complications. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cristen N Litz
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States.
| | - Jessica B Asuncion
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States.
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States.
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States.
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Appropriateness of Surgical Antibiotic Prophylaxis in Pediatric Patients in Italy. Infect Control Hosp Epidemiol 2017; 38:823-831. [DOI: 10.1017/ice.2017.79] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVESAppropriate use of surgical antibiotic prophylaxis (SAP) reduces intraoperative wound contamination in pediatric surgery, thus minimizing the risk of surgical site infection (SSIs). Conversely, inappropriate use of SAP exposes patients to the risk of antibiotic side effects and contributes to the emergence of antimicrobial resistance. Our aims were to describe SAP administration and to analyze factors associated with nonadherence in pediatric patients.DESIGNDescriptive study.SETTINGOverall, 955 pediatric patients underwent 1,038 surgical procedures.METHODSWe assessed adherence to SAP international guidelines for surgical procedures performed on children aged <18 years in 2015 in 4 randomly selected hospitals in Calabria (Italy). The clinical records of these patients were retrospectively reviewed.RESULTSAppropriate SAP administration or nonadministration pertained to 754 surgical procedures (72.6%). Surgical antibiotic prophylaxis was administered in 88.5% of 358 procedures with an SAP indication. Adherence to guidelines for appropriate drug choice were followed in 5.7% of cases, for route of administration in 76.7% of cases, for timing in 48.6% of cases, for duration in 14.5% of cases, and for dose in 91.5% of cases, and for all components in only 5 cases (1.6%). Among 680 procedures without SAP indication, 35.7% case patients received antibiotics. Inappropriate administration of antibiotics in procedures without SAP indication was associated with surgical specialty wards (P=.008), ordinary admission (P<.001), head and neck surgical procedures (P=.020), clean surgery (P=.017), and surgical duration (P=.010).CONCLUSIONSDiscrepancies between SAP guidelines and actual practice behavior more frequently indicate excessive use of antibiotics than underuse. Increased awareness of SAP guidelines is required.Infect Control Hosp Epidemiol 2017;38:823–831
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Sviestina I, Mozgis J, Mozgis D. Analysis of antibiotic surgical prophylaxis in hospitalized children suffering upper and lower extremity injuries. Int J Clin Pharm 2016; 38:233-7. [DOI: 10.1007/s11096-016-0274-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 02/26/2016] [Indexed: 11/29/2022]
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12
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Sviestina I, Mozgis D. Antimicrobial usage among hospitalized children in Latvia: a neonatal and pediatric antimicrobial point prevalence survey. MEDICINA-LITHUANIA 2014; 50:175-81. [PMID: 25323546 DOI: 10.1016/j.medici.2014.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/03/2014] [Accepted: 07/03/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The point prevalence survey was conducted as part of the Antibiotic Resistance and Prescribing in European Children (ARPEC) Project. The study aimed at analyzing pediatric and neonatal antimicrobial prescribing patterns in Latvian hospitals, to identify targets for quality improvement. MATERIALS AND METHODS A one day cross-sectional point prevalence survey on antibiotic use in hospitalized children was conducted in November 2012 in 10 Latvian hospitals, using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antimicrobial treatment on the day of survey. RESULTS Overall 549 patients were included in the study; 167 (39%) patients admitted to pediatric wards and 25 (21%) patients admitted to neonatal wards received at least one antimicrobial. Pediatric top three antibiotic groups were third-generation cephalosporins (55 prescriptions, 28%), extended spectrum penicillins (n=32, 16%) and first-generation cephalosporins (n=26, 13%). Eleven pediatric patients (85%) received surgical prophylaxis more than 1 day; 143 pediatric patients (86%) received antibiotics intravenously. Lower respiratory tract infections were the most common indications for antibiotic use both in pediatric (n=60, 35.9%) and neonatal patients (n=9, 36%). The most used antibiotics for neonatal patients were benzylpenicillin (n=12, 32%), and gentamicin (n=9, 24%). CONCLUSIONS We identified a few problematic areas, which need improvement: the high use of third-generation cephalosporins for pediatric patients, prolonged surgical prophylaxis, predominant use of parenteral antibiotics and an urgent need for local antibiotic guidelines.
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Affiliation(s)
- Inese Sviestina
- University Children's Hospital, Riga, Latvia; Faculty of Pharmacy, Riga Stradins University, Riga, Latvia.
| | - Dzintars Mozgis
- Public Health and Epidemiology Department, Riga Stradins University, Riga, Latvia
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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: 698] [Impact Index Per Article: 63.5] [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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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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Recent trends in the use of antibiotic prophylaxis in pediatric surgery. J Pediatr Surg 2011; 46:366-71. [PMID: 21292089 DOI: 10.1016/j.jpedsurg.2010.11.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 11/04/2010] [Indexed: 11/20/2022]
Abstract
AIMS The use of surgical antibiotic prophylaxis (AP) in children is poorly characterized. The aims of this study were to examine (1) trends in the use of AP for commonly performed operations, (2) appropriateness in the context of available guidelines, and (3) adverse events potentially attributable to AP. METHODS We conducted a 5-year retrospective analysis of 22 children's hospitals (January 2005-March 2009) for all patients younger than 18 years who underwent 1 of the 40 commonly performed general and urological procedures. Indications for AP were defined by published specialty-specific guidelines. Clostridium difficile infection and surrogate events for drug allergy (diphenhydramine and epinephrine administrations) were examined as potential antibiotic-associated adverse events. RESULTS Procedures of 246,316 were identified, of which 25% met criteria for AP. Eighty-two percent of the children received antibiotics during procedures when AP was indicated (range, 60%-96% by hospital), and 40% of the patients received antibiotics when there was no indication (range, 10%-83%). The likelihood of receiving AP was significantly different between hospitals for all procedures examined (P < .0001 for each procedure). Adverse events were significantly more frequent in children receiving AP than in those who did not (odds ratio [95% confidence interval] C difficile: 18.8 [6.9-51.5], P < .0001; epinephrine: 1.8 [1.7-2.0], P < .0001; diphenhydramine: 6.0 [5.6-6.5], P < .0001). CONCLUSIONS Significant variation exists in the use of AP in the pediatric surgical population. Many children do not receive AP when indicated, and an even greater proportion may receive antibiotics when there is no indication. These findings may have profound implications from a public health perspective when extrapolated to all children undergoing surgical procedures.
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Castro BA. The immunocompromised pediatric patient and surgery. Best Pract Res Clin Anaesthesiol 2008; 22:611-26. [DOI: 10.1016/j.bpa.2008.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Leal J, Laupland KB. Validity of electronic surveillance systems: a systematic review. J Hosp Infect 2008; 69:220-9. [PMID: 18550211 DOI: 10.1016/j.jhin.2008.04.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 04/23/2008] [Indexed: 10/22/2022]
Abstract
Electronic surveillance that utilises information held in databases is more efficient than conventional infection surveillance methods. Validity is not well-defined, however. We systematically reviewed studies comparing the utility of electronic and conventional surveillance methods. Publications were identified using Medline (1980-2007) and bibliographic review. The sensitivity and specificity of electronic compared with conventional surveillance was reported. Twenty-four studies were included. Six studies reported that nosocomial infections could be detected utilising microbiology data alone with good overall sensitivity (range: 63-91%) and excellent specificity (range: 87 to >99%). Two studies used three laboratory-based algorithms for the detection of infection outbreaks yielding variable utility measures (sensitivity, range: 43-91%; specificity, range: 67-86%). Seven studies using only administrative data including discharge coding (International Classification of Diseases, 9th edn, Clinical Modification) and pharmacy data claimed databases had good sensitivity (range: 59-96%) and excellent specificity (range: 95 to >99%) in detecting nosocomial infections. Six studies combined both laboratory and administrative data for a range of infections, and overall had higher sensitivity (range: 71-94%) but lower specificity (range: 47 to >99%) than with use of either alone. Three studies evaluated community-acquired infections with variable results. Electronic surveillance has moderate to excellent utility compared with conventional methods for nosocomial infections. Future studies are needed to refine electronic algorithms further, especially with community-onset infections.
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Affiliation(s)
- J Leal
- Department of Community Health Sciences, University of Calgary, Calgary Health Region, Calgary, Alberta, Canada
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Breckler FD, Fuchs JR, Rescorla FJ. Survey of pediatric surgeons on current practices of bowel preparation for elective colorectal surgery in children. Am J Surg 2007; 193:315-8; discussion 318. [PMID: 17320526 DOI: 10.1016/j.amjsurg.2006.09.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Revised: 09/20/2006] [Accepted: 09/20/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Guidelines regarding bowel preparation exist for the adult but not the pediatric population. Our aim was to evaluate the bowel preparation practices, including antibiotic usage for elective colorectal operations in children. METHODS A survey was designed and administered to a nationwide group of pediatric surgeons to ascertain current practices of bowel preparation. RESULTS Four hundred ninety-three surveys were administered, and 136 physicians responded (28%). Mechanical bowel preparation was used by 96% of the respondents. Preoperative intravenous antibiotics were used by 99% of respondents. The number of years in practice did not significantly affect the use of oral antibiotics (P = .62) or the duration of intravenous antibiotics (P = .78). CONCLUSIONS There is a wide variation in bowel preparation practices in children. A prospective, randomized trial would be helpful to identify the role of oral antibiotics and optimal duration of intravenous antibiotics in this population.
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Affiliation(s)
- Francine D Breckler
- James Whitcomb Riley Hospital for Children, Department of Pharmacy, Clarian Health Partners, Room 1016, 702 Barnhill Drive, Indianapolis, IN 46202, USA.
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