Antibiotic stewardship in the newborn surgical patient: A quality improvement project in the neonatal intensive care unit. Surgery 2017 Dec;162(6):1295-1303
Date
10/21/2017Pubmed ID
29050887DOI
10.1016/j.surg.2017.07.021Scopus ID
2-s2.0-85031665314 (requires institutional sign-in at Scopus site) 30 CitationsAbstract
BACKGROUND: There is significant diversity in the utilization of antibiotics for neonates undergoing surgical procedures. Our institution standardized antibiotic administration for surgical neonates, in which no empiric antibiotics were given to infants with surgical conditions postnatally, and antibiotics are given no more than 72 hours perioperatively.
METHODS: We compared the time periods before and after implementation of antibiotic protocol in an institution review board-approved, retrospective review of neonates with congenital surgical conditions who underwent surgical correction within 30 days after birth. Surgical site infection at 30 days was the primary outcome, and development of hospital-acquired infections or multidrug-resistant organism were secondary outcomes.
RESULTS: One hundred forty-eight infants underwent surgical procedures pre-protocol, and 127 underwent procedures post-protocol implementation. Surgical site infection rates were similar pre- and post-protocol, 14% and 9% respectively, (P = .21.) The incidence of hospital-acquired infections (13.7% vs 8.7%, P = .205) and multidrug-resistant organism (4.7% vs 1.6%, P = .143) was similar between the 2 periods.
CONCLUSION: Elimination of empiric postnatal antibiotics did not statistically change rates of surgical site infection, hospital-acquired infections, or multidrug-resistant organisms. Limiting the duration of perioperative antibiotic prophylaxis to no more than 72 hours after surgery did not increase the rate of surgical site infection, hospital-acquired infections, or multidrug-resistant organism. Median antibiotic days were decreased with antibiotic standardization for surgical neonates.
Author List
Walker S, Datta A, Massoumi RL, Gross ER, Uhing M, Arca MJAuthor
Michael R. Uhing MD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Anti-Bacterial AgentsAntibiotic Prophylaxis
Antimicrobial Stewardship
Drug Administration Schedule
Female
Guideline Adherence
Humans
Incidence
Infant, Newborn
Intensive Care Units, Neonatal
Intensive Care, Neonatal
Male
Perioperative Care
Practice Guidelines as Topic
Quality Improvement
Retrospective Studies
Surgical Wound Infection
Time Factors
Treatment Outcome