Boston—Appropriate use of surgical antibiotic prophylaxis (AP) reduces surgical site-infection rates, but is it always necessary?

A study published online recently by JAMA Pediatrics sought to assess national variability and appropriateness of AP in pediatric surgical patients.

An investigative team led by Boston Children’s Hospital researchers performed a retrospective cohort study of 31 freestanding children’s hospitals in the United States using administrative data from 2010 to 2013. Including 603,734 children younger than 18 years, mostly boys with average age of 4.8 years, the study focused on the 45 most commonly performed surgical procedures, with primary outcomes including procedure- and hospital-specific rates of AP use and appropriateness of use based on clinical guidelines and consensus statements.

Study authors also assessed rates of Clostridium difficile infection and potential allergic reactions, using epinephrine administration as a surrogate event, after antibiotics were administered.

Results indicate that for the 671,255 procedures evaluated, AP was administered in 53% of them. Variation was high among hospitals, however, with use of presurgery antibiotics ranging from 11.5% to 100%, for a median of 78.1%.

“Overall, AP use was considered appropriate for 64.6% of cases,” study authors report. “Appropriate use of AP by hospital varied from 47.3% to 84.4% with large variability by procedure within each hospital.”

For procedures for which AP was indicated, the median rate of appropriate use by hospital was 93.8%. On the other hand, for procedures for which AP was not indicated, the median rate of appropriate use by hospital was 52.0%.

In addition, the study found that the odds of C. difficile infection and epinephrine administration were significantly higher among children who received prophylactic antibiotics, odds ratio, 3.34 and 1.97, respectively.

“There is substantial national variability in the overall and appropriate use of AP for the most commonly performed operations in children both at a procedure and hospital level,” study authors write. “A high proportion of AP use is inappropriate, potentially exposing many children to avoidable adverse events. Urgent attention should be directed to efforts to standardize the use of surgical AP in pediatrics.”

« Click here to return to Weekly News Update.