Abstract
Purpose
The use of surgical antibiotic prophylaxis (SAP) in children is poorly characterized. Our aim was to evaluate the effectiveness of a quality improvement (QI) intervention targeting SAP in children, by means of a multicenter prospective intervention study, with a before and after design.
Methods
We prospectively investigated elective surgical procedures performed in children <18 years, prior to the QI intervention, after the intervention and at 9-month follow-up. The primary outcomes were adherence to SAP indications and SAP appropriateness, defined considering antibiotic choice, timing of first dose and duration of administration. We compared SAP adherence and appropriateness prior the QI intervention, to the post-intervention and the follow-up. We considered patient and procedure characteristics as covariates in two logistic regression models to assess the effect of the QI intervention on SAP adherence and appropriateness.
Results
We collected information on 2383 procedures (pre-intervention: 784; post-intervention: 790; follow-up: 809). The QI intervention had a significant impact on the adherence to SAP indications (86.6% in the post-intervention, compared to 82.0% prior to the intervention; p < 0.05), and on its appropriateness (35.7% compared to 19.9%; p < 0.01). The impact of the intervention on SAP appropriateness was maintained at follow-up (38.3%; p < 0.01 compared to pre-intervention). All components of SAP appropriateness significantly improved after the intervention and at follow-up. The logistic regression analyses confirmed the effect of intervention in improving adherence to SAP indications and appropriateness.
Conclusions
Following the QI intervention, there was a significant improvement in quality of SAP in pediatric surgery, though more efforts are needed to increase SAP appropriateness.
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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 Massimo Ciafrei, Giordano Bruno and Claudia Iannillo (ISIA, Rome, Italy) for their support in developing educational material, and Francesco Gesualdo for his valuable assistance in revising the manuscript.
The APACHE Study Group: Massimiliano Raponi (Principal Investigator) Marta Ciofi degli Atti (Unit Coordinator), Antonella Falcone, Valerio Paolini, Flaminia Passi, Desirée Rubei, Serena Tucci - Bambino Gesù Children’s Hospital, Piazza Sant’Onofrio 4 – 00165 Rome, Italy; Pasquale Arace (Unit Coordinator), Antonio Di Martino, Scipione D’Orio - Ospedale Santobono Pausilipon, Via Della Croce Rossa 8 - 80122 Naples, Italy; Raffaele Spiazzi (Unit Coordinator), Renata Franceschini, Lucia Corasaniti, Anna Merla - Ospedale dei Bambini di Brescia, Piazzale Spedali Civili 1 - 25123 Brescia, Italy; Angela Giusti (Unit Coordinator, from 2014), Roberto Raschetti (Unit Coordinator, 2012-2013), Stefania Spila Alegiani, Sofia Colaceci – Italian National Institute of Health, Viale Regina Elena 299 – 00161Rome, Italy.
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MCDA participated in the design, interpretation and writing the manuscript. SSA performed the research, analyzed data and contributed to the interpretation, and writing the manuscript. RR, PA, AG, SR and MR contributed to study design, and commented the manuscript. The other component of the Apache Study Group performed the research and commented the manuscript. All authors read and approved.
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This work was supported by a research grant from the Italian Medicine Agency (FARM9PJNAJ – 2012). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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The authors declare that they have no conflict of interest.
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Ciofi degli Atti, M., Alegiani, S.S., Raschetti, R. et al. A collaborative intervention to improve surgical antibiotic prophylaxis in children: results from a prospective multicenter study. Eur J Clin Pharmacol 73, 1141–1147 (2017). https://doi.org/10.1007/s00228-017-2270-y
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DOI: https://doi.org/10.1007/s00228-017-2270-y