Understanding antibiotic prophylaxis prescribing in pediatric surgical specialties
Open accessAbstract
BACKGROUND: Overuse of antibiotics has caused secondary poor outcomes and has led to a current rate of antibiotic resistant infections that constitutes a public health crisis. In pediatric surgical specialties, children continue to receive unnecessary antibiotics. OBJECTIVE: To understand the factors that contribute to pediatric surgeons' decisions regarding the use of perioperative antibiotic prophylaxis. METHODS: Focus groups included pediatric proceduralists/surgeons from the following specialties: interventional cardiology, otolaryngology, orthopedic surgery, cardiothoracic surgery, and general surgery. RESULTS: A total of 23 surgeons with a median of 9 years of experience (range, 0.5-29 years) participated in the focus groups that lasted 30-90 minutes each. Five themes emerged influencing beliefs about antibiotic prescribing practices: (1) reliance on previous experience and early education, (2) balancing antibiotic use with risk of infection, (3) uncertainty about the state of the scientific evidence, (4) understanding importance of communication and team collaboration, and (5) a prevalence of hospital-level concerns. CONCLUSIONS: Surgeons describe a complex set of factors that impact their antibiotic prescribing in pediatric surgical cases. They reported initial, but not ongoing, training and a use of individual weight of risk and benefit as a major dictator of prescribing practices. Antimicrobial stewardship programs should work with surgeons to develop acceptable implementation strategies to optimize antibiotic prescribing.
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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 [20]
The Methods describe focus groups about antibiotic prophylaxis prescribing among pediatric surgeons, so the paper supports the citation’s identification of a prophylaxis-focused study. But the Methods place the study at a children’s hospital with approval from Washington University in St Louis, not in an LMIC; the paper also does not assess whether LMIC studies overlook postoperative empirical antibiotic use. (LLM, conf=0.84)
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Malone, S., Newland, J., Kudchadkar, S. R., Prewitt, K., McKay, V., Prusaczyk, B., Proctor, E., Brownson, R. C., & Luke, D. A. (2022) · Frontiers in Health Services · doi:10.3389/frhs.2022.1005802 · Cited by 6 · see citing works
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- Authors
- Malone, S. M., Seigel, N. S., Newland, J. G., Saito, J. M., & McKay, V. R.
- Affiliations
- Washington University in St. Louis (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Malone, Sara M.
- Venue
- Infection Control & Hospital Epidemiology
- Publisher
- Cambridge University Press (CUP)
- Published
- 2020-04-07
- Volume
- 41
- Issue
- 6
- Pages
- 666-671
- ISSN
- 0899-823X (ISSN-L)
- 1559-6834
- PMC
- PMC8202117
- OpenAlex
- W3014258309
- Cited by
- 26
- References
- 29
- Citations by year
- 2026: 9 · 2025: 4 · 2024: 1 · 2023: 4 · 2022: 7 · 2020: 1
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Infection Control and Hospital Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR002345)
- Agency for Healthcare Research and Quality (R01 HS026742)
- National Center for Advancing Translational Sciences
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- antibiotic prophylaxis, pediatric surgery, antibiotic overuse, antimicrobial resistance, risk-benefit decision-making, antimicrobial stewardship, surgical training, team collaboration
- MeSH terms
- Antimicrobial Stewardship, Anti-Bacterial Agents, Child, Humans, Practice Patterns, Physicians', Specialties, Surgical, Focus Groups, Antibiotic Prophylaxis
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