Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery.

TitleEffectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery.
Publication TypeJournal Article
Year of Publication2020
AuthorsDonĂ  D, Luise D, Barbieri E, Masiero N, Maita S, Antoniello L, Zaoutis T, Giaquinto C, Gamba P
JournalPathogens
Volume9
Issue6
Date Published2020 Jun 19
ISSN2076-0817
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 ( < 0.001). Cefazolin was the most used antibiotic, with a significant increase in the post-intervention period ( < 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 ( = 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.

DOI10.3390/pathogens9060490
Alternate JournalPathogens
PubMed ID32575542