Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA.
Ann Surg. 2023 Jul 1;278(1):e158-e164. doi: 10.1097/SLA.0000000000005480. Epub 2022 Jul 7.
To quantify procedure-level inappropriate antimicrobial prophylaxis utilization as a strategy to identify high-priority targets for stewardship efforts in pediatric surgery.
Little data exist to guide the prioritization of antibiotic stewardship efforts as they relate to prophylaxis utilization in pediatric surgery.
This was a retrospective cohort analysis of children undergoing elective surgical procedures at 52 children's hospitals from October 2015 to December 2019 using the Pediatric Health Information System database. Procedure-level compliance with consensus guidelines for prophylaxis utilization was assessed for indication, antimicrobial spectrum, and duration. The relative contribution of each procedure to the overall burden of noncompliant cases was calculated to establish a prioritization framework for stewardship efforts.
A total of 56,845 cases were included with an overall inappropriate utilization rate of 56%. The most common reason for noncompliance was unindicated utilization (43%), followed by prolonged duration (32%) and use of excessively broad-spectrum agents (25%). Procedures with the greatest relative contribution to noncompliant cases included cholecystectomy and repair of inguinal and umbilical hernias for unindicated utilization (63.2% of all cases); small bowel resections, gastrostomy, and colorectal procedures for use of excessively broad-spectrum agents (70.1%) and pectus excavatum repair and procedures involving the small and large bowel for prolonged duration (57.6%). More than half of all noncompliant cases were associated with 5 procedures (cholecystectomy, small bowel procedures, inguinal hernia repair, gastrostomy, and pectus excavatum).
Cholecystectomy, inguinal hernia repair, and procedures involving the small and large bowel should be considered high-priority targets for antimicrobial stewardship efforts in pediatric surgery.
通过量化手术过程中不合理使用抗菌预防药物的情况，为小儿外科学中抗生素管理措施确定高优先级目标提供策略依据。
在小儿外科学中，抗菌预防药物的使用与抗生素管理措施密切相关，但相关数据较少。
本研究采用回顾性队列分析方法，使用儿童健康信息系统数据库，对 2015 年 10 月至 2019 年 12 月期间在 52 家儿童医院接受择期手术的 56845 例患儿进行分析。评估手术过程中预防用药的适应证、抗菌谱和用药时间是否符合共识指南，计算每个手术对整体不合规病例的相对贡献，从而建立管理措施的优先级框架。
共纳入 56845 例患儿，整体不合理使用的发生率为 56%。最常见的不规范使用原因是无适应证使用（43%），其次是用药时间过长（32%）和使用广谱抗菌药物（25%）。导致不合规病例最多的手术包括胆囊切除术和腹股沟疝及脐疝修补术，原因是无适应证使用（占所有病例的 63.2%）；小肠切除术、胃造口术和结直肠手术，原因是使用广谱抗菌药物（占 70.1%）；漏斗胸矫正术和涉及小肠和大肠的手术，原因是用药时间过长（占 57.6%）。超过一半的不合规病例与 5 种手术相关（胆囊切除术、小肠手术、腹股沟疝修补术、胃造口术和漏斗胸矫正术）。
在小儿外科学中，应将胆囊切除术、腹股沟疝修补术和涉及小肠和大肠的手术作为抗菌药物管理措施的高优先级目标。
