Pediatric cardiothoracic (CT) surgery poses significant infectious risks, mitigated by antimicrobial prophylaxis and standardized infection control practices. Little is known about the most appropriate postoperative antimicrobial regimen and duration of therapy. In efforts to decrease exposure to broad-spectrum (BS) antimicrobial prophylaxis while preventing postoperative infection, we implemented a risk-stratified algorithm CT surgery prophylaxis algorithm (Fig. 1) at our institution.
This quasi-experimental study included pediatric CT surgery patients at an urban academic medical center. Algorithm implementation in conjunction with daily prospective audit-with-feedback started simultaneously in Sept 2017, with retrospective review of pre- and post-intervention groups. Data related to length of hospital admission, narrow and BS antimicrobial days and appropriateness, infectious complications, and drug toxicity were collected. The preliminary pre-intervention arm was compared to the post-intervention arm using descriptive statistics via SPSS.
Preliminary data suggests a trend towards decreased BS antimicrobial use in the post-intervention group by 27%, with a significant decrease in the rate of inappropriate use during the post-intervention period. There were no episodes of drug-related nephrotoxicity.
Continued review is ongoing; however, risk-based limited-spectrum antimicrobial therapy for pediatric CT surgery patients appears efficacious and safe while limiting antimicrobial exposure.
Figure 1. Process map for pediatric cardiothoracic surgery algorithm.
R. L. Medernach,
J. Jacobson, None
K. Welsh, None
S. Brown, None
A. Wilhelmi, None
C. Nash, None
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