Effects of an antimicrobial stewardship intervention on perioperative antibiotic prophylaxis in pediatrics

Daniele Donà,
Dora LuiseEmail author View ORCID ID profile,
Enrico La Pergola,
Genni Montemezzo,
Annachiara Frigo,
Rebecca Lundin,
Theoklis Zaoutis,
Piergiorgio Gamba and
Carlo Giaquinto

Antimicrobial Resistance & Infection Control20198:13

https://doi.org/10.1186/s13756-019-0464-z

Received: 30 August 2018
Accepted: 3 January 2019
Published: 15 January 2019

Abstract

Purpose

This study aims to determine the effectiveness of an Antimicrobial Stewardship Program based on a Clinical Pathway (CP) to improve appropriateness in perioperative antibiotic prophylaxis (PAP).

Materials and methods

This pre-post quasi-experimental study was conducted in a 12 month period (six months before and six months after CP implementation), in a tertiary Pediatric Surgical Centre. All patients from 1 month to 15 years of age receiving one or more surgical procedures were eligible for inclusion. PAP was defined appropriate according to clinical practice guidelines.

Results

Seven hundred sixty-six children were included in the study, 394 in pre-intervention and 372 in post-intervention. After CP implementation, there was an increase in appropriate PAP administration, as well as in the selection of the appropriate antibiotic for prophylaxis, both for monotherapy (p = 0.02) and combination therapy (p = 0.004). Even the duration of prophylaxis decreased during the post-intervention period, with an increase of correct PAP discontinuation from 45.1 to 66.7% (p < 0.001). Despite the greater use of narrow-spectrum antibiotic for fewer days, there was no increase in treatment failures (10/394 (2.5%) pre vs 7/372 (1.9%) post, p = 0.54).