Abstract
Appropriate use of antibiotic prophylaxis (AP) is a key measure for the prevention of surgical site infections (SSI) in colorectal surgeries; however, despite the presence of national and international guidelines, compliance with AP recommendations remains low. The purpose of this study is to evaluate compliance with recommendations for the use of AP in children undergoing colorectal surgeries and to evaluate the effectiveness of antibiotics in the prevention of SSI. We collected demographic and clinical characteristics of patients who underwent colorectal surgeries, as well as microbiological and antimicrobial susceptibility data for patients who developed SSI. AP data were collected and compared with national guidelines. Antibiotic dosing and duration were most frequently in concordance with national guidelines, while antibiotic timing and selection had the lowest rates of compliance. Twelve of the 192 colorectal procedures evaluated resulted in SSI. Only 2 of the 12 children with SSI received appropriate AP for all four categories evaluated. Eight cases that resulted in SSI were due to organisms not covered by the recommended AP. We identified multiple areas for the improvement of AP in children undergoing colorectal surgery. A multidisciplinary approach to development of standardized protocols, educational interventions, and EHR-based algorithms may facilitate or improve appropriate AP use.
Highlights
IntroductionAccording to the Centers for Disease Control and Prevention (CDC), surgical site infections (SSI)
According to the Centers for Disease Control and Prevention (CDC), surgical site infections (SSI)are infections that occur at or near the surgical incision within 30 days of a procedure, or 90 days for specified procedures [1]
The purpose of this study is to evaluate the compliance of surgeons to national recommendations for use of antibiotic prophylaxis (AP) in children undergoing colorectal surgeries with particular regard to antibiotic selection, dose, timing prior to incision and intraoperative re-dosing, and duration of postoperative antibiotic use and is to evaluate the effectiveness of antibiotics in the prevention of SSI in children undergoing colorectal surgical procedures
Summary
According to the Centers for Disease Control and Prevention (CDC), surgical site infections (SSI). Are infections that occur at or near the surgical incision within 30 days of a procedure, or 90 days for specified procedures [1]. These infections occur in approximately 2–5% of patients undergoing inpatient surgery in the United States, and account for approximately 20% of healthcare-associated infections in adults as well as children [2]. Committee for the Prevention of Surgical Site Infection recommend appropriate utilization of systemic antibiotic prophylaxis (AP) within a surgical bundle as a key measure to prevent SSI among patients undergoing colorectal surgeries [8]. In 2016, the World Health Organization published evidence-based recommendations regarding the use of AP in the prevention of SSI [1,2,9,10,11,12]
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