An evaluation of antimicrobial prophylaxis in paediatric surgery and its financial implication

Abstract

To assess the appropriateness of use of antimicrobial prophylaxis in paediatric surgery in Singapore. A prospective evaluation of the use of antimicrobial prophylaxis in paediatric patients undergoing surgery in KK Hospital, Singapore was carried out from September and December 2001. Process measures for the study included adherence to local or international guidelines, choice and dose of antimicrobial agent and timing and duration of prophylaxis. Outcome measures included surgical site and other related infections. A cost analysis was also performed to look at the extra expenditure due to any excessive use of antimicrobials. A total of 171 patients with a mean age of 5.7 years (SD=4.5) were included in the study. Among the 117 (68.4%) elective and 54 (31.6%) emergency procedures, 22 cases (12.8%) were fully compliant with the guidelines. The most frequently encountered non-compliance types were unnecessary prolongation of prophylaxis (54.4%), inappropriate choice of antibiotics (42.7%) and overdose of antibiotics (26.3%). The estimated extra cost to patients for the study period was Sing$13,879.41 (US 8164.36). The results showed a significantly high level of inappropriate use of antimicrobial prophylaxis in paediatric surgery in Singapore. However, when the individual factors such as appropriate choice of antibiotics, appropriate timing and duration were considered, the situation was very similar to the results obtained from overseas studies.