Procedure-Level Misutilization of Antimicrobial Prophylaxis in Pediatric Surgery: Implications for Improved Stewardship and More Effective Infection Prevention

• Published in: Journal of pediatric surgery Vol. 58; no. 6; pp. 1116 - 1122
• Main Authors: He, Katherine, Iwaniuk, Marie, Goretsky, Michael J., Cina, Robert A., Saito, Jacqueline M., Hall, Bruce, Grant, Catherine, Cohen, Mark E., Newland, Jason G., Ko, Clifford Y., Rangel, Shawn J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2023
• Subjects: Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents; Antibiotic Prophylaxis - methods; Antibiotic stewardship; Child; Colorectal Neoplasms - drug therapy; Humans; Retrospective Studies; Surgical prophylaxis; Surgical site infection; Surgical Wound; Surgical Wound Infection - drug therapy; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; ICD-10; ASHP; CPT; PHIS; SSI; EA/TEF; IDSA; ACS NSQIP-Pediatric; SHEA; Surgical site infection; Surgical prophylaxis; Antibiotic stewardship; SIS; CHA
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2023.02.024

The objective of this study was to quantify prophylaxis misutilization to identify high-priority procedures for improved stewardship and SSI prevention. This was a multicenter analysis including 90 hospitals participating in the NSQIP-Pediatric Antibiotic Prophylaxis Collaborative from 6/2019 to 6/2020. Prophylaxis data were collected from all hospitals and misutilization measures were developed from consensus guidelines. Overutilization included use of overly broad-spectrum agents, continuation of prophylaxis >24 h after incision closure, and use in clean procedures without implants. Underutilization included omission (clean-contaminated cases), use of inappropriately narrow-spectrum agents, and administration post-incision. Procedure-level misutilization burden was estimated by multiplying NSQIP-derived misutilization rates by case volume data obtained from the Pediatric Health Information System database. 9861 patients were included. Overutilization was most commonly associated with overly broad-spectrum agents (14.0%), unindicated utilization (12.6%), and prolonged duration (8.4%). Procedure groups with the greatest overutilization burden included small bowel (27.2%), cholecystectomy (24.4%), and colorectal (10.7%). Underutilization was most commonly associated with post-incision administration (6.2%), inappropriate omission (4.4%), and overly narrow-spectrum agents (4.1%). Procedure groups with the greatest underutilization burden included colorectal (31.2%), gastrostomy (19.2%), and small bowel (11.1%). A relatively small number of procedures account for a disproportionate burden of antibiotic misutilization in pediatric surgery. Retrospective Cohort. III. •In this multicenter analysis of 9861 children, 70.6% of prophylaxis misutilization was associated with overutilization.•Overutilization was due to overly broad-spectrum agents (14.0%), unindicated use (12.6%), and prolonged duration (8.4%).•Cholecystectomy, small bowel and colorectal procedures were associated with more than half of all cases of overutilization.