29: Descriptive Analysis of Paediatric Antimicrobial Prophylaxis in Surgery in Four University Teaching Hospitals

Abstract

BACKGROUND: Antimicrobial prophylaxis is used in surgical patients to prevent wound infection because this possible complication is associated with increased patient morbidity and increased costs for the health-care system. New guidelines have been recently published. OBJECTIVES: To describe how antimicrobial prophylaxis was used in paediatric patients at our centers, and to review if prescription was in accordance with the new guidelines. DESIGN/METHODS: A descriptive retrospective analysis for paediatric patients admitted to four university hospitals and who underwent selected surgeries (cardiac, appendectomies, closed fracture, scoliosis) between April 1st 2012 and March 31st 2013. Compliance criteria evaluated were choice of antibiotic, dosage, duration and timing of administration. The utilization of pre-printed orders for the prescription of antibiotics used in surgical antimicrobial prophylaxis was another aspect evaluated. RESULTS: A total of 222 children were included in the compliance analysis. For all surgeries, the choice and the duration of therapy showed the highest compliance scores (>85%), except for cardiac surgery (duration: 63%). Criteria for dosage and timing of dose administration showed varying scores, according to the types of surgery (scores for dosage from 18% to 100% and scores for timing from 65% to 100%). In particular, cefazolin doses were quite variable (from 13 mg/kg/dose to 50 mg/kg/dose), and the maximal dose prescribed (in grams/dose) was often found to be lower than recommended. As seen in the table, global compliance to all criteria (choice, dosage, timing of administration, duration) was also quite variable according to the type of surgery. Finally, utilization of pre-printed orders was infrequent (<20%). CONCLUSION: For several types of surgery, a relatively low percentage of paediatric patients received optimal prophylactic antibiotic treatment based on the four essential criteria. Many recommendations have been made to improve current practice. (Table Presented).