Trends in the use of surgical antibiotic prophylaxis in general pediatric surgery: are we missing the mark for both stewardship and infection prevention?
Abstract
Background The purpose of this study was to assess compliance with antimicrobial spectrum guidelines in the use of surgical antibiotic prophylaxis (SAP) in pediatric surgery.Methods A retrospective cohort study of children undergoing elective clean-contaminated and clean surgical procedures with foreign body implantation using the Pediatric Health Information System database (10/2015-6/2018) was performed. Compliance rates with consensus guidelines surrounding appropriate spectrum of SAP coverage were calculated for each procedure. Undertreatment was defined as the use of SAP with inappropriately narrow coverage (or omission altogether), while overtreatment was defined as inappropriately broad coverage.Results Eight procedure groups including a total of 15,708 patients were included. Overall, 44% of cases received inappropriate prophylaxis, of which 58% were considered undertreatment and 42% overtreatment. Procedures with the highest rates of overtreatment included small bowel procedures (77%), colorectal procedures (29%), and hepatobiliary procedures (20%), while the highest rates of undertreatment were associated with placement of tunneled central venous catheters and ports (43%), hepatobiliary procedures (24%), and colorectal procedures (20%).Conclusion Noncompliance with the recommended spectrum of coverage for surgical antibiotic prophylaxis is common in pediatric surgery, with both over and undertreatment being common themes. Improved compliance is needed to optimize both antibiotic stewardship and infection prevention.Type of study Treatment study.Level of evidence Level III.
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Studies in LMICs focus on surgical prophylaxis, overlooking the extent of post-operative empirical antibiotic use.
“The studies in LMICs focus on surgical prophylaxis,17–20 overlooking the extent of post-operative empirical antibiotic use.”
From Rationalizing irrational prescribing—infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India (2024) · cites this paper as [18]
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- Authors
- Anandalwar, S. P., Milliren, C., Graham, D. A., Hills-Dunlap, J. L., Kashtan, M. A., Newland, J., & Rangel, S. J.
- Affiliations
- Boston Children's Hospital (US)
- Washington University in St. Louis (US)
- Corresponding author
- Rangel, Shawn J.
- ORCID
- Venue
- Journal of Pediatric Surgery
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 55
- Issue
- 1
- Pages
- 75-79
- ISSN
- 0022-3468 (ISSN-L)
- OpenAlex
- W2982157935
- Cited by
- 30
- References
- 25
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 4 · 2023: 4 · 2022: 6 · 2020: 2
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pediatric Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Surgery › Orthopedic Infections and Treatments
- Keywords
- surgical antibiotic prophylaxis, pediatric surgery, antibiotic stewardship, infection control, undertreatment, overtreatment, guideline adherence, foreign body implantation, small bowel surgery, colorectal surgery, hepatobiliary surgery, central venous catheters
- MeSH terms
- Medical Overuse, Antimicrobial Stewardship, Adolescent, Anti-Bacterial Agents, Child, Female, Humans, Male, Practice Patterns, Physicians', Retrospective Studies, Surgical Wound Infection, United States, Databases, Factual, Practice Guidelines as Topic, Elective Surgical Procedures, Antibiotic Prophylaxis, Guideline Adherence
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