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Open AccessArticle

Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery

1
Paediatric Infectious Diseases Unit—Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
2
Infectious Diseases Department, Verona University Hospital, 37134 Verona, Italy
3
Paediatric Surgery Unit—Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
4
Division of Infectious Diseases, Department of Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
*
Author to whom correspondence should be addressed.
Pathogens 2020, 9(6), 490; https://doi.org/10.3390/pathogens9060490
Received: 26 May 2020 / Revised: 15 June 2020 / Accepted: 17 June 2020 / Published: 19 June 2020
Background—Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim—The aim of this study is to determine the effectiveness and long-term sustainability of an antimicrobial stewardship program (ASP), based on a clinical pathway (CP) and periodic education, to improve adherence to the guidelines for PAP in a tertiary care pediatric surgery center. Methods—We assessed the changes in PAP correctness and its effect on SSIs between the six months before and the 24 months after the implementation of ASP in the Pediatric Surgery Unit of the Department of Women’s and Children’s Health of Padova. The ASP was addressed to all surgeons and anesthesiologists of the Pediatric Surgery Unit. The primary outcome was appropriateness of PAP (agent, timing of the first dose, and duration). SSI rate was the secondary outcome. Results—1771 patients were included in the study and 676 received PAP. The overall correctness of the PAP, in terms of agent, timing, and duration, increased significantly after the CP implementation. What changed most was the PAP discontinuation within 24 h (p < 0.001). Cefazolin was the most used antibiotic, with a significant increase in the post-intervention period (p < 0.001) and with a reduction in the use of other broad-spectrum antibiotics. No variations in the incidence of SSIs were reported in the five periods (p = 0.958). Conclusion—The implementation of an ASP based on CP and education is an effective and sustainable antimicrobial stewardship tool for improving the correct use of PAP. View Full-Text
Keywords: antimicrobial stewardship; surgical site infection; perioperative prophylaxis; pediatric surgery; clinical pathways antimicrobial stewardship; surgical site infection; perioperative prophylaxis; pediatric surgery; clinical pathways
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Donà, D.; Luise, D.; Barbieri, E.; Masiero, N.; Maita, S.; Antoniello, L.; Zaoutis, T.; Giaquinto, C.; Gamba, P. Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery. Pathogens 2020, 9, 490.

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