Pathan Sohilkhan R, Bhende Vishal V, Sharma Tanishq S, Kumar Amit, Patel Vishal A, Sharma Kruti B, Pandya Shivangi B
Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND.
Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND.
Cureus. 2023 Sep 12;15(9):e45107. doi: 10.7759/cureus.45107. eCollection 2023 Sep.
Introduction Antimicrobial prophylaxis, involving short antibiotic courses preceding surgical procedures, is recommended to minimize postoperative infections. Paediatric cardiac surgeries are classified as clean procedures, though infection challenges persist due to illness severity and extended ICU stays. Antimicrobial prophylaxis varies, ranging from single doses to extended administration until catheters are removed. Typically lasting 24 to 48 hours, it has proven infection-reduction benefits. Despite these practices, uncertainties surround the optimal nature, timing, and duration of administration. This concern is amplified by escalating antimicrobial resistance driven by antibiotic overuse. Vulnerable paediatric populations bear heightened consequences of irrational antimicrobial use, contributing to global resistance trends. Yet, a defined optimal prophylaxis schedule for paediatric cardiac surgery is lacking. Importing adult guidelines may be inadequate due to paediatric research complexities and population diversity. Developing effective prophylaxis protocols is crucial for children undergoing cardiac surgery, given global antibiotic overuse and evolving drug resistance. Establishing an optimal prophylactic strategy remains a challenge, necessitating further research for evidence-based protocols to mitigate infections in this vulnerable patient cohort. Methods This study investigates antibiotic use in paediatric cardiac surgery. A retrospective analysis of 100 patients from a rural Indian hospital (2017-2018) assesses antibiotic patterns, including type, dose, duration, and adherence to prophylaxis protocols. Results In the studied cohort of paediatric cardiac surgery patients, complete compliance (100%) with antibiotic prophylaxis was observed. However, deviations were identified: 30% received antibiotics prematurely, and 30% did not align with institutional protocol criteria. Concerning antibiotic selection, 87% followed hospital policy with the recommended cefoperazone and sulbactam combination plus amikacin, while 9% received piperacillin/tazobactam + amikacin due to sepsis. Irregular use (22%) based on clinical records occurred. Furthermore, 4% received piperacillin/tazobactam + teicoplanin, with one instance of inappropriate higher antibiotic use. Regarding prophylaxis duration, only 27% adhered to the appropriate timeline, with 40% exceeding 48 hours, indicating extended use. Upon discharge, a notable proportion (45 patients) received antibiotic prescriptions. Among them, 73% were prescribed rationally, while 27% exhibited irrational antibiotic use. Conclusion The findings of this study shed a significant light on the issue of antibiotic misuse within the context of paediatric cardiac surgery. It underscores the pressing need for more stringent measures to regulate and address this concerning trend. The study underscores the pivotal importance of adhering rigorously to established protocols and guidelines for antibiotic prophylaxis. This adherence not only holds the potential to elevate the overall quality of patient care but also plays a critical role in combating the escalating challenge of antibiotic resistance. Through a concerted effort to optimize antibiotic usage, we can simultaneously enhance patient outcomes and contribute to the ongoing fight against the emergence of antibiotic-resistant strains, thus preserving the efficacy of these vital medications for future generations.
引言
抗菌预防措施，即在外科手术前进行短期抗生素治疗，被推荐用于尽量减少术后感染。儿科心脏手术被归类为清洁手术，尽管由于病情严重程度和重症监护病房停留时间延长，感染挑战依然存在。抗菌预防措施各不相同，从单剂量到延长给药直至导管拔除。通常持续24至48小时，已证明具有减少感染的益处。尽管有这些做法，但关于给药的最佳性质、时间和持续时间仍存在不确定性。抗生素过度使用导致的抗菌耐药性不断升级，加剧了这一担忧。脆弱的儿科人群承受着不合理使用抗菌药物带来的更严重后果，这助长了全球耐药趋势。然而，目前缺乏针对儿科心脏手术的明确最佳预防方案。由于儿科研究的复杂性和人群多样性，照搬成人指南可能并不充分。鉴于全球抗生素过度使用和不断演变的耐药性，制定有效的预防方案对于接受心脏手术的儿童至关重要。制定最佳预防策略仍然是一项挑战，需要进一步研究以制定基于证据的方案，以减轻这一脆弱患者群体的感染。
方法
本研究调查儿科心脏手术中的抗生素使用情况。对一家印度农村医院（2017 - 2018年）的100名患者进行回顾性分析，评估抗生素使用模式，包括类型、剂量、持续时间以及对预防方案的依从性。
结果
在研究的儿科心脏手术患者队列中，观察到对抗菌预防措施的完全依从率为100%。然而，也发现了一些偏差：30%的患者过早接受抗生素治疗，30%的患者不符合机构方案标准。关于抗生素选择，87%的患者遵循医院政策使用推荐的头孢哌酮和舒巴坦联合阿米卡星，而9%的患者因败血症接受哌拉西林/他唑巴坦 + 阿米卡星治疗。根据临床记录，出现了22%的不规律使用情况。此外，4%的患者接受哌拉西林/他唑巴坦 + 替考拉宁治疗，其中有一例抗生素使用不当且剂量过高。关于预防持续时间，只有27%的患者遵循了适当的时间线，40%的患者超过了48小时，表明存在延长使用的情况。出院时，相当一部分患者（45例）收到了抗生素处方。其中，73%的处方是合理的，而27%表现出不合理的抗生素使用。
结论
本研究结果显著揭示了儿科心脏手术中抗生素滥用的问题。它强调了采取更严格措施来规范和解决这一令人担忧的趋势的迫切需求。该研究强调了严格遵守既定的抗生素预防方案和指南的关键重要性。这种遵守不仅有可能提高整体患者护理质量，而且在应对不断升级的抗生素耐药性挑战方面也起着关键作用。通过共同努力优化抗生素使用，我们可以同时改善患者预后，并为持续抗击抗生素耐药菌株的出现做出贡献，从而为子孙后代保留这些重要药物的疗效。
