Analysis of antibiotic surgical prophylaxis in hospitalized children suffering upper and lower extremity injuries

Abstract

Background: Surgical prophylaxis may account for one-third of all antibiotic use in paediatric hospitals.

Objective: To evaluate the appropriateness of surgical prophylaxis and to analyse adherence of surgeons to surgical prophylaxis guidelines.

Method: Retrospective study at a university paediatric hospital. Patients younger than 18 years with injuries of lower and upper extremities were included. The study period was from January 1st 2011-December 31st 2013 and January 1st 2001-December 31st 2003. The appropriateness of the antibiotic use was analysed in accordance with international and local guidelines.

Results: Antibiotic prophylaxis was needed by 1125 (55.0 %) patients in 2011-2013 and by 816 (44.4 %) patients in 2001-2003. However, it was administered to only 66.0 % of those in need of prophylaxis in 2011-2013 and to 70.8 % of those in 2001-2003. A single antibiotic dose was administered to 73.8 % of those who received antibiotics in 2011-2013 and to 34.1 % of those in 2001-2003. The timing of the first dose was correct in 370 (52.9 %) prescriptions in 2011-2013 and in 10 (20.4 %) prescriptions in 2001-2003. The most often used antibiotics for prophylaxis were cefazolin in 2011-2013 and cefuroxime in 2001-2003.

Conclusion: Overall adherence rate to the international and hospital guidelines was low, indicating that in order to improve this situation, there is a need for multiple interventions.

Keywords: Antibiotics; Extremities; Injuries; Latvia; Paediatrics; Surgical prophylaxis.