Abstract
Background—Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim—The aim of this study is to determine the effectiveness and long-term sustainability of an antimicrobial stewardship program (ASP), based on a clinical pathway (CP) and periodic education, to improve adherence to the guidelines for PAP in a tertiary care pediatric surgery center. Methods—We assessed the changes in PAP correctness and its effect on SSIs between the six months before and the 24 months after the implementation of ASP in the Pediatric Surgery Unit of the Department of Women’s and Children’s Health of Padova. The ASP was addressed to all surgeons and anesthesiologists of the Pediatric Surgery Unit. The primary outcome was appropriateness of PAP (agent, timing of the first dose, and duration). SSI rate was the secondary outcome. Results—1771 patients were included in the study and 676 received PAP. The overall correctness of the PAP, in terms of agent, timing, and duration, increased significantly after the CP implementation. What changed most was the PAP discontinuation within 24 h (p < 0.001). Cefazolin was the most used antibiotic, with a significant increase in the post-intervention period (p < 0.001) and with a reduction in the use of other broad-spectrum antibiotics. No variations in the incidence of SSIs were reported in the five periods (p = 0.958). Conclusion—The implementation of an ASP based on CP and education is an effective and sustainable antimicrobial stewardship tool for improving the correct use of PAP.
Highlights
Controlling and preventing antibiotic misuse through antimicrobial stewardship programs Controlling and preventing antibiotic misusethe through antimicrobial stewardship programs (ASPs), on the other hand, is crucial to prevent incidence of bacterial resistances that are(ASPs), a wellon the other hand, is crucial to prevent the incidence of bacterial resistances that are a well-known known threat for hospitalized patients [3]
ASPs for perioperative antibiotic prophylaxis (PAP) are targeted to the adult population, with only
We assessed the changes in PAP correctness and its effect on SSIs in the 24 months after implementation of ASP in the Pediatric Surgery Unit of the Department of Women’s and Children’s the implementation of ASP in the Pediatric Surgery Unit of the Department of Women’s and Children’s
Summary
Perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs), which represent the second most common healthcare-associated infection and, according to the Centers for Diseases Control, complicate around 5% of surgical procedures every year [1,2].Pathogens 2020, 9, 490; doi:10.3390/pathogens9060490 www.mdpi.com/journal/pathogens PathogensPathogens2020, 2020,9,9,490 x FOR PEER REVIEW 22of of99Controlling and preventing antibiotic misuse through antimicrobial stewardship programs Controlling and preventing antibiotic misusethe through antimicrobial stewardship programs (ASPs), on the other hand, is crucial to prevent incidence of bacterial resistances that are(ASPs), a wellon the other hand, is crucial to prevent the incidence of bacterial resistances that are a well-known known threat for hospitalized patients [3].threatMost for hospitalized patients [3].of the studies investigatingASPs for PAP are targeted to the adult population, with onlyMost of the studies investigatingPAPefficacy are targeted to the of adult population, few focusing on children and limitedASPs data for on the and safety these strategies with [4,5,6,7].only. ASPs for PAP are targeted to the adult population, with only. Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim—The aim of this study is to determine the effectiveness and long-term sustainability of an antimicrobial stewardship program (ASP), based on a clinical pathway (CP) and periodic education, to improve adherence to the guidelines for PAP in a tertiary care pediatric surgery center. Methods—We assessed the changes in PAP correctness and its effect on SSIs between the six months before and the 24 months after the implementation of ASP in the Pediatric Surgery Unit of the Department of Women’s and Children’s. The overall correctness of the PAP, in terms of agent, timing, and duration, increased significantly after the CP implementation.
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