From the Mount Sinai Hospital, Toronto, Ontario, Canada.
University of Montreal, Montreal, Quebec, Canada.
Pediatr Infect Dis J. 2020 Jan;39(1):48-53. doi: 10.1097/INF.0000000000002490.
Data from rigorous evaluations of the impact of interventions on improving surgical antibiotic prophylaxis (SAP) compliance in pediatrics are lacking. Our objective was to assess the impact of a multifaceted intervention on improving pediatric SAP compliance in a hospital without an ongoing antimicrobial stewardship program.
A multidisciplinary team at the Montreal Children's Hospital performed a series of interventions designed to improve pediatric SAP compliance in June 2015. A retrospective, quasi-experimental study was performed to assess SAP compliance before and following the interventions. Our study included patients under 18 years old undergoing surgery between April and September in 2013 (preintervention) and in 2016 (postintervention). A 10-week washout period was included to rigorously assess the persistence of compliance without ongoing interventions. SAP, when indicated, was qualified as noncompliant, partially compliant (adequate agent and timing) or totally compliant (adequate agent, dose, timing, readministration, duration).
A total of 982 surgical cases requiring SAP were included in our primary analysis. The composite partial and total compliance increased from 51.4% to 55.8% [adjusted odds ratio 1.3; 95% confidence interval: 1.0-1.8; P = 0.06]. Although improvements in correct dose and readministration were significant, there was no significant improvement in correct timing, agent selection or duration.
Our study demonstrated that overall SAP compliance did not significantly improve following a washout period, illustrating the importance of ongoing surveillance and feedback from an antimicrobial stewardship program. Our strict approach in evaluating the timing criterion may also explain the lack of a significant impact on SAP compliance.
缺乏严格评估干预措施对改善儿科手术抗生素预防（SAP）依从性影响的数据。我们的目的是评估一项多方面干预措施对改善无持续抗菌药物管理计划的医院儿科 SAP 依从性的影响。
蒙特利尔儿童医院的一个多学科团队在 2015 年 6 月进行了一系列旨在提高儿科 SAP 依从性的干预措施。进行了回顾性准实验研究，以评估干预前后 SAP 的依从性。我们的研究包括 2013 年 4 月至 9 月（干预前）和 2016 年（干预后）期间接受手术的 18 岁以下患者。包括 10 周的洗脱期，以严格评估无持续干预措施时的依从性持续情况。当需要 SAP 时，将 SAP 定性为不依从、部分依从（适当的药物和时机）或完全依从（适当的药物、剂量、时机、重新给药、持续时间）。
我们的主要分析共纳入了 982 例需要 SAP 的手术病例。复合部分和总依从性从 51.4%增加到 55.8%[调整后的优势比 1.3；95%置信区间：1.0-1.8；P=0.06]。虽然正确剂量和重新给药的改善具有统计学意义，但正确时机、药物选择或持续时间的改善没有统计学意义。
我们的研究表明，在洗脱期后，SAP 整体依从性并没有显著提高，这说明了持续的监测和来自抗菌药物管理计划的反馈的重要性。我们在评估时机标准时采取的严格方法也可能解释了 SAP 依从性没有显著影响的原因。
