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Surgical antibiotic prophylaxis in children: adherence to indication, choice of agent, timing, and duration

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Surgical antibiotic prophylaxis (SAP) in children is poorly characterized. We investigated SAP for children undergoing elective surgical procedures.

Methods

We prospectively investigated elective surgical procedures performed in children <18 years, from November 2012 to February 2013, in three tertiary-care children’s hospitals in Italy. Data were derived from clinical records. Antibiotics were considered prophylactic if given by parenteral route during the same day of the procedure. SAP indication was defined according to international guidelines. Whenever SAP was indicated, it was defined appropriate if antibiotic choice was different from third-/fourth-generation cephalosporins, carbapenems, or piperacillin/tazobactam; timing of first dose was within 60 min before incision; and duration of administration was ≤24 h. Multivariable logistic regression model was used to assess independent predictors of adherence to SAP administration, for procedures with SAP indication performed in all hospitals.

Results

Data on 765 procedures were collected. SAP was administered in 81 % of 206 procedures with SAP indication and in 18 % of 559 procedures with no indication. Type of procedure and hospital were significantly associated with adherence of administration to SAP indication. In the 206 procedures where SAP was indicated, overall appropriateness of antibiotic choice, timing, and duration was 8 %.

Conclusions

The SAP rate observed in procedures with SAP indication and the appropriateness of drug choice, timing, and duration are reasons of concern. Quality improvement interventions for implementing SAP recommendations in children are strongly needed, and their impact should be evaluated at hospital level.

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Acknowledgments

We wish to thank all the staff, patients, and families who made this study possible. We also wish to thank Dr. Francesco Gesualdo for his valuable assistance in revising the manuscript.

Conflict of interest

The authors have declared that no competing interests exist.

Author information

Authors and Affiliations

  1. Clinical Epidemiology Unit, Medical Direction, Bambino Gesù Children’s Hospital, Rome, Italy

    Marta Ciofi degli Atti

  2. National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy

    Stefania Spila Alegiani, Roberto Raschetti & Angela Giusti

  3. Medical Direction, Ospedale Santobono Pausilipon, Naples, Italy

    Pasquale Arace

  4. Medical Direction, Ospedale dei Bambini di Brescia, Brescia, Italy

    Raffaele Spiazzi

  5. Medical Direction, Bambino Gesù Children’s Hospital, Rome, Italy

    Massimiliano Raponi

Authors
  1. Marta Ciofi degli Atti
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  2. Stefania Spila Alegiani
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  3. Roberto Raschetti
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  4. Pasquale Arace
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  5. Angela Giusti
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  6. Raffaele Spiazzi
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  7. Massimiliano Raponi
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Consortia

the APACHE Study Group

Corresponding author

Correspondence to Marta Ciofi degli Atti.

Additional information

Components of the APACHE Study Group

Principal Investigator

Massimiliano Raponi, Bambino Gesù Children’s Hospital, Rome, Italy

Units

Bambino Gesù Children’s Hospital, Rome, Italy: Marta Ciofi degli Atti (Coordinator), Antonella Falcone, Valerio Paolini, Flaminia Passi, Desirée Rubei, Serena Tucci

Ospedale Santobono Pausilipon, Naples, Italy: Pasquale Arace (Coordinator), Antonio Di Martino, Scipione D’Orio

Ospedale dei Bambini di Brescia, Brescia, Italy: Raffaele Spiazzi (Coordinator), Renata Franceschini, Lucia Corasaniti, Anna Merla

National Institute of Health, Rome, Italy: Angela Giusti (Coordinator, from 2014), Roberto Raschetti (Coordinator, 2012-2013), Stefania Spila Alegiani

Electronic supplementary material

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Figure; Supplementary document

Administration of surgical antibiotic prophylaxis (SAP) for procedures when SAP was indicated and not indicated by recommended guidelines. (GIF 37 kb)

High Resolution Image (EPS 913 kb)

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Ciofi degli Atti, M., Spila Alegiani, S., Raschetti, R. et al. Surgical antibiotic prophylaxis in children: adherence to indication, choice of agent, timing, and duration. Eur J Clin Pharmacol 71, 483–488 (2015). https://doi.org/10.1007/s00228-015-1816-0

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  • DOI: https://doi.org/10.1007/s00228-015-1816-0

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