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

PurposeThis 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 methodsThis pre-post quasi-experimental study was conducted in a 12month period (six months before and six months after CP implementation), in a tertiary Pediatric Surgical Centre. All patients from 1month to 15years of age receiving one or more surgical procedures were eligible for inclusion. PAP was defined appropriate according to clinical practice guidelines.ResultsSeven 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).ConclusionsCPs can be a useful tool to improve the choice of antibiotic and the duration of PAP in pediatric patients.