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Pattern of antibiotic prophylaxis usage and timing of administration in common paediatric surgeries: a retrospective cross-sectional study in teaching hospitals

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Abstract

Background and objective

Surgical site infections (SSIs) are among the common problems associated with paediatric surgeries and significantly contribute to postsurgical morbidity and mortality. This study was conducted to assess antimicrobial prophylaxis practices and compliance rates with international guidelines in common paediatric surgical procedures.

Methods

A retrospective cross-sectional study was conducted in paediatric patients aged < 18 years in whom four common surgeries (inguinal hernia, appendectomy, bariatric surgery and pancreaticoduodenectomy) were performed at paediatric wards during August 2015 to August 2016 in two tertiary care teaching hospitals. Compliance with antimicrobial prophylaxis practice guidelines (selection, timing and pattern of antimicrobial usage) was evaluated.

Results

The charts of 1152 eligible paediatric patients were reviewed. Among these, 66.5% (n = 766) were male and 33.5% (n = 386) were female, with a mean age of 8.4 years (standard deviation ± 5.6). Inguinal hernia was the most frequent surgical procedure conducted (36.3% of patients), followed by appendectomy (25.4%), bariatric surgery (21.9%) and pancreaticoduodenectomy (16.5%). Complete compliance with guidelines was observed in 11.2% of patients (129 of 1152). The choice of antimicrobial prophylaxis administration was appropriate in 380 cases (33%), with a higher rate of guideline adherence with appendectomy than with inguinal hernia, pancreaticoduodenectomy, and bariatric surgical procedures (55.8% vs 32%, 23.1% and 15.5%; p < 0.0001). The timing was appropriate in 490 patients (42.5%), with a higher rate in appendectomy (51%) than in other paediatric procedures (p < 0.0001). The majority of patients were managed with ceftriaxone (46%) or cefazolin (26.5%). A statistically significant difference was observed regarding antimicrobial prophylaxis prescribing practices in the hospitals (p < 0.0001).

Conclusion

Low rates of adherence to guidelines in selected paediatric surgeries were observed. Increased awareness among surgeons and formulation of institutional and national antimicrobial prophylaxis guidelines are required.

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Acknowledgements

The authors acknowledge the administration of both hospitals for their support and help during data collection. The authors also acknowledge the contribution of Associate Professor. Dr. Hazir Rahman, Department of Microbiology, Faculty of Chemical and Life Sciences, Abdul Wali Khan University, Mardan, Pakistan to this study.

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Authors and Affiliations

  1. Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320, Pakistan

    Zakir Khan, Naveed Ahmed & Asim ur Rehman

  2. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Health Science Centre, Xi’an Jiaotong University, Xi’an, China

    Faiz Ullah Khan

  3. Department of Statistics, Quaid-i-Azam University, Islamabad, 45320, Pakistan

    Syed Muhammad Hamid

Authors
  1. Zakir Khan
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  2. Naveed Ahmed
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  3. Asim ur Rehman
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  4. Faiz Ullah Khan
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Contributions

ZK, NA, AUR were involved in the concept, design and data collection of the study. FUK and SMH carried out the statistical analysis. All authors were involved in the interpretation of the data. ZK wrote the first draft of the manuscript, and all authors contributed to subsequent drafts.

Corresponding author

Correspondence to Zakir Khan.

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Conflict of interest

All authors declare no potential conflicts of interest.

Ethical approval

Approval from the institutional ethics committees of GH and PH were obtained prior to conducting the study.

Funding

The study did not have a funding source.

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Khan, Z., Ahmed, N., ur Rehman, A. et al. Pattern of antibiotic prophylaxis usage and timing of administration in common paediatric surgeries: a retrospective cross-sectional study in teaching hospitals. Drugs Ther Perspect 36, 26–32 (2020). https://doi.org/10.1007/s40267-019-00692-y

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