1035. Practice Survey of Prophylactic Antibiotic Use in Pediatric Orthopedic Surgery
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • POSTER 1035 NOOR.pdf (667.4 kB)
  • Background: Incidence of surgical site infection (SSI) in pediatric orthopedic surgery depends on host factors and the type of procedure. SSI is lower after idiopathic scoliosis repair (0.5-6.7%) as opposed to neuromuscular scoliosis repair (4.3-14.3%). Antibiotic prophylaxis (AP) is one of the modifiable factors shown to prevent SSI. We hypothesize overuse of AP in pediatric orthopedic surgery.  

    Methods: A limited national survey of 70 orthopedic programs across United States was conducted. We used Survey Monkey with Enhanced security (SSL/HTTPS) properties. It is a qualitative study and we included 4 procedures, each with specific risk factors for SSI.

    We took into account the surgeon’s demographic and clinical practice information and collected data on antibiotic choice, timing, and Methicillin resistant Staphylococcus aureus (MRSA) screen. We aim to survey members of pediatric orthopedic society of North America to validate our results.

    Results: 80 started and 64 completed the survey (80%). Training: 47 (58%) attendings, 31 (38%) residents, 1 nurse practitioner (1.3%) and 1 physician assistant (1.3%). Fellowship: 38 (47%) not trained, 32 (40%) pediatric, 5 (6%) spine, 4 (5%) trauma and 1 (1.3%) oncology. Experience: 35 (44%) 1-5 yrs, 17 (21%) 6-10 yr, 14 (18%) 11-20 yrs and 13 (16%) have > 20 yrs.

    In spinal fusion for neuromuscular scoliosis, antibiotic use: 23 (52%) cefazolin, 9 (20 %) vancomycin, and 12 (27 %) use cefazolin combination with gentamicin (8), tobramycin (1) and ceftriaxone (3). Timing: 16 (34%) continue AP > 24 hrs. MRSA screen is not done by 29 (62%). In spinal fusion for idiopathic scoliosis, antibiotic use: 44 (96%) cefazolin, 1 (2%) vancomycin and 1 ceftriaxone (2 %). Timing: 12 (26%) continue AP > 24 hrs. MRSA screen is not done by 28 (63%).

    In supracondylar fracture with open reduction, antibiotic use: 58 (97%) cefazolin, 1 (3%) gentamicin. Timing: 9 (16%) continue AP > 24 hrs. In tibial fracture with closed reduction, antibiotic: 58 (98%) cefazolin. Timing: none use >24 hrs.

    Conclusion: A greater variability of antibiotic choice is seen in spinal fusion procedure for neuromuscular scoliosis. The type of procedure affects the length of AP use to be > 24 hours and most do not use MRSA screen/decolonization strategies.

    Asif Noor, MBBS, Pediatrics, Stony Brook University Hospital, Stony Brook, NY and Sharon Nachman, MD, Pediatrics, HSC SUNY, Stony Brook, NY; SUNY Stony Brook, Stony Brook, NY


    A. Noor, None

    S. Nachman, None

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