Reduction of surgical site infections in pediatric patients with complicated appendicitis: Utilization of antibiotic stewardship principles and quality improvement methodology
| Autor: | Brenda L Tesini, Michael H. Livingston, Walter Pegoli, Peter Juviler, Derek Wakeman, Cassandra L. Gleason, Marjorie J. Arca, Nicole A. Wilson, Elizabeth Levatino |
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| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
Quality management Percutaneous medicine.drug_class Antibiotics Tazobactam Antimicrobial Stewardship medicine Appendectomy Humans Surgical Wound Infection Child Retrospective Studies business.industry General Medicine Guideline Emergency department Appendicitis medicine.disease Quality Improvement Anti-Bacterial Agents Treatment Outcome Pediatrics Perinatology and Child Health Emergency medicine Surgery business Piperacillin medicine.drug |
| Zdroj: | Journal of Pediatric Surgery. 57:63-73 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2021.09.031 |
| Popis: | Background The rate of surgical site infection (SSI) after appendectomy for complicated appendicitis (CA) was high at our children's hospital. We hypothesized that practice standardization, including obtaining intra-operative cultures of abdominal fluid in patients with CA, would improve outcomes and reduce healthcare utilization after appendectomy. Methods A quality improvement team designed and implemented a clinical practice guideline for CA that included obtaining intra-operative culture of purulent fluid, administering piperacillin/tazobactam for at least 72 h post-operatively, and transitioning to oral antibiotics based on intraoperative culture data. We compared outcomes before and after guideline implementation. Results From July 2018-October 2019, 63 children underwent appendectomy for CA compared to 41 children from January-December 2020. Compliance with our process measures are as follows: Intra-operative culture was obtained in 98% of patients post-implementation; 95% received at least 72 h of piperacillin-tazobactam; and culture results were checked on all patients. Culture results altered the choice of discharge antibiotics in 12 (29%) of patients. All-cause morbidity (SSI, emergency department visit, readmission to hospital, percutaneous drain, unplanned return to operating room) decreased significantly from 35% to 15% (p=0.02). Surgical site infections became less frequent, occurring on average every 27 days pre-implementation and every 60 days after care pathway implementation (p=0.03). Conclusions Utilization of a clinical practice guideline was associated with reduced morbidity after appendectomy for CA. Intra-operative fluid culture during appendectomy for CA appears to facilitate the selection of appropriate post-operative antibiotics and, thus, minimize SSIs and overall morbidity. |
| Databáze: | OpenAIRE |
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