sábado, 19 de enero de 2019

Effects of an antimicrobial stewardship intervention on perioperative antibiotic prophylaxis in pediatrics | Antimicrobial Resistance & Infection Control | Full Text

Effects of an antimicrobial stewardship intervention on perioperative antibiotic prophylaxis in pediatrics | Antimicrobial Resistance & Infection Control | Full Text

Antimicrobial Resistance & Infection Control

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Effects of an antimicrobial stewardship intervention on perioperative antibiotic prophylaxis in pediatrics

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Antimicrobial Resistance & Infection Control20198:13
  • Received: 30 August 2018
  • Accepted: 3 January 2019
  • Published: 

Abstract

Purpose

This study aims to determine the effectiveness of an Antimicrobial Stewardship Program based on a Clinical Pathway (CP) to improve appropriateness in perioperative antibiotic prophylaxis (PAP).

Materials and methods

This pre-post quasi-experimental study was conducted in a 12 month period (six months before and six months after CP implementation), in a tertiary Pediatric Surgical Centre. All patients from 1 month to 15 years of age receiving one or more surgical procedures were eligible for inclusion. PAP was defined appropriate according to clinical practice guidelines.

Results

Seven hundred sixty-six children were included in the study, 394 in pre-intervention and 372 in post-intervention. After CP implementation, there was an increase in appropriate PAP administration, as well as in the selection of the appropriate antibiotic for prophylaxis, both for monotherapy (p = 0.02) and combination therapy (p = 0.004). Even the duration of prophylaxis decreased during the post-intervention period, with an increase of correct PAP discontinuation from 45.1 to 66.7% (p < 0.001). Despite the greater use of narrow-spectrum antibiotic for fewer days, there was no increase in treatment failures (10/394 (2.5%) pre vs 7/372 (1.9%) post, p = 0.54).

Conclusions

CPs can be a useful tool to improve the choice of antibiotic and the duration of PAP in pediatric patients.

Keywords

  • Perioperative antimicrobial prophylaxis
  • Antimicrobial stewardship
  • Clinical pathway
  • Pediatric surgery

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