Nav: Home

Surgical antibiotic prophylaxis use, appropriateness varies in children's hospitals

April 18, 2016

A new study found substantial variability in the use and appropriateness of surgical antibiotic prophylaxis for commonly performed operations at children's hospitals in the United States, according to an article published online by JAMA Pediatrics.

Surgical site infection (SSI) is a common complication of adult and pediatric surgery. Appropriate use of perioperative surgical antibiotic prophylaxis (AP) can help to minimize the incidence of SSI in procedures for which AP is indicated. However, inappropriate AP use can have potentially negative consequences, including adverse drug events, Clostridium difficile infection, the emergence of antibiotic resistant organisms and increased health care costs. The trend in surgical AP use for pediatric patients is not well understood.

Thomas J. Sandora. M.D., M.P.H., of Boston Children's Hospital, and coauthors analyzed administrative data from 31 freestanding children's hospitals in the United States from 2010 to 2013.

The study included 603,734 children younger than 18 who had one of the 45 most commonly performed operations. The average age of the children was nearly 5 years old and almost 64 percent were boys.

For the 671,255 operations evaluated, the authors report AP was administered for 348,119 (52 percent) of procedures. Overall, AP use was considered appropriate for 64.6 percent of cases. Appropriate use of AP varied by hospital from 47.3 percent to 84.4 percent and there was larger variability by procedure within each hospital.

When AP was indicated for a procedure, the median rate of appropriate use by hospital was 93.8 percent; when AP was not indicated, the median rate of appropriate use by hospital was 52 percent, according to the results.

The likelihood of Clostridium difficile infection and the administration of epinephrine was higher in children who received AP, the study reports.

The lack of pediatric-specific guidelines for AP use is perhaps the most likely contributing factor to explain variation in AP use between and within hospitals and procedures.

The study includes several limitations, including the possibility of misclassification in administrative data.

"Surgical antibiotic prophylaxis is associated with both potential benefits and risks for individual patients, and it has important public health implications on a population level with respect to antibiotic resistance and health care costs. Additional research is urgently needed to document the procedure-specific risk of SSI among pediatric patients and to establish strategies to improve AP use for children to prevent SSI and minimize unintended consequences," the authors conclude.
-end-
(JAMA Pediatr. Published online April 18, 2016. doi:10.1001/jamapediatrics.2016.0019. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see article for additional information, including other authors, author contributions and affiliations, etc.

Media Advisory: To contact corresponding author Thomas J. Sandora, M.D., M.P.H., call Rob Graham at 617-919-3111 or email rob.graham@childrens.harvard.edu.

The JAMA Network Journals

Related Children Articles:

Do children inherently want to help others?
A new special section of the journal Child Development includes a collection of ten empirical articles and one theoretical article focusing on the predictors, outcomes, and mechanisms related to children's motivations for prosocial actions, such as helping and sharing.
Children need conventional CPR; black and Hispanic children more likely to get Hands-Only
While compressions-only or Hands-Only CPR is as good as conventional CPR for adults, children benefit more from the conventional approach that includes rescue breaths.
Cohen Children's Medical Center study: Children on autism spectrum more likely to wander, disappear
A new study by researchers at Cohen Children's Medical Center of New York suggests that more than one-quarter million school-age children with autism spectrum disorder or other developmental disorders wander away from adult supervision each year.
The importance of children at play
Research highlights positive strengths in developmental learning for Latino children in low-income households based on their interactive play skills.
Racial disparities in pain children of children with appendicitis in EDs
Black children were less likely to receive any pain medication for moderate pain and less likely to receive opioids for severe pain than white children in a study of racial disparities in the pain management of children with appendicitis in emergency departments, according to an article published online by JAMA Pediatrics.
UofL offers vaccine trial for children with relapsed tumors at Kosair Children's Hospital
Children with relapsed tumors and their parents are finding hope in a Phase I research study led by Kenneth G.
Dana-Farber/Boston Children's opens immunotherapy trial for children with leukemia
Dana-Farber/Boston Children's Cancer and Blood Disorders Center has joined a clinical trial of immunotherapy for children with relapsed or treatment-resistant acute lymphoblastic leukemia (ALL).
Children less likely to come to the rescue when others are available
Children as young as 5 years old are less likely to help a person in need when other children are present and available to help, according to new research published in Psychological Science, a journal of the Association for Psychological Science.
IPT for children with anaemia
Researchers from Tanzania and South Africa, who are part of the Cochrane Infectious Disease Group, hosted at LSTM, have conducted an independent review to assess the effect of intermittent preventive antimalarial treatment for children with anaemia living in malaria endemic regions.
Safety first, children
Children are experts at getting into danger. So, how can parents help prevent the consequences?

Related Children Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...