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A collaborative intervention to improve surgical antibiotic prophylaxis in children: results from a prospective multicenter study.

Abstract：

PURPOSE:The use of surgical antibiotic prophylaxis (SAP) in children is poorly characterized. Our aim was to evaluate the effectiveness of a quality improvement (QI) intervention targeting SAP in children, by means of a multicenter prospective intervention study, with a before and after design. METHODS:We prospectively investigated elective surgical procedures performed in children <18 years, prior to the QI intervention, after the intervention and at 9-month follow-up. The primary outcomes were adherence to SAP indications and SAP appropriateness, defined considering antibiotic choice, timing of first dose and duration of administration. We compared SAP adherence and appropriateness prior the QI intervention, to the post-intervention and the follow-up. We considered patient and procedure characteristics as covariates in two logistic regression models to assess the effect of the QI intervention on SAP adherence and appropriateness. RESULTS:We collected information on 2383 procedures (pre-intervention: 784; post-intervention: 790; follow-up: 809). The QI intervention had a significant impact on the adherence to SAP indications (86.6% in the post-intervention, compared to 82.0% prior to the intervention; p < 0.05), and on its appropriateness (35.7% compared to 19.9%; p < 0.01). The impact of the intervention on SAP appropriateness was maintained at follow-up (38.3%; p < 0.01 compared to pre-intervention). All components of SAP appropriateness significantly improved after the intervention and at follow-up. The logistic regression analyses confirmed the effect of intervention in improving adherence to SAP indications and appropriateness. CONCLUSIONS:Following the QI intervention, there was a significant improvement in quality of SAP in pediatric surgery, though more efforts are needed to increase SAP appropriateness.

journal_name

Eur J Clin Pharmacol

journal_title

European journal of clinical pharmacology

authors

Ciofi Degli Atti M,Alegiani SS,Raschetti R,Arace P,Giusti A,Spiazzi R,Raponi M,APACHE Study Group.

doi

10.1007/s00228-017-2270-y

subject

Has Abstract

pub_date

2017-09-01 00:00:00

pages

1141-1147

issue

9

eissn

0031-6970

issn

1432-1041

pii

10.1007/s00228-017-2270-y

journal_volume

73

pub_type

临床试验,杂志文章,多中心研究

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