Clinical Pathways Can Improve the Choice of Antibiotic and PAP Duration in Pediatric Patients

January 25, 2019

A study by Donà, et al. (2019) aimed to determine the effectiveness of an antimicrobial stewardship program based on a clinical pathway (CP) to improve appropriateness in perioperative antibiotic prophylaxis (PAP).

This pre-post quasi-experimental study was conducted in a 12-month period (six months before and six months after CP implementation) in a tertiary pediatric surgery center. All patients from 1 month to 15 years of age receiving one or more surgical procedures were eligible for inclusion. PAP was defined appropriate according to clinical practice guidelines.

Seven-hundred sixty-six children were included in the study, 394 in pre-intervention and 372 in post-intervention. After CP implementation, there was an increase in appropriate PAP administration, as well as in the selection of the appropriate antibiotic for prophylaxis, both for monotherapy (p = 0.02) and combination therapy (p = 0.004). Even the duration of prophylaxis decreased during the post-intervention period, with an increase of correct PAP discontinuation from 45.1 to 66.7% (p < 0.001). Despite the greater use of narrow-spectrum antibiotic for fewer days, there was no increase in treatment failures (10/394 (2.5%) pre vs 7/372 (1.9%) post, p = 0.54).

The researchers concluded that CPs can be a useful tool to improve the choice of antibiotic and the duration of PAP in pediatric patients.

Reference: Donà D, et al. Effects of an antimicrobial stewardship intervention on perioperative antibiotic prophylaxis in pediatrics. Antimicrobial Resistance & Infection Control.2019;8:13