title: Recent trends in the use of antibiotic prophylaxis in pediatric surgery.
abstract: OBJECTIVE
  The use of surgical antibiotic prophylaxis (AP) in children is poorly characterized. The aims of this study were to examine (1) trends in the use of AP for commonly performed operations, (2) appropriateness in the context of available guidelines, and (3) adverse events potentially attributable to AP.
  
  
  METHODS
  We conducted a 5-year retrospective analysis of 22 children's hospitals (January 2005-March 2009) for all patients younger than 18 years who underwent 1 of the 40 commonly performed general and urological procedures. Indications for AP were defined by published specialty-specific guidelines. Clostridium difficile infection and surrogate events for drug allergy (diphenhydramine and epinephrine administrations) were examined as potential antibiotic-associated adverse events.
  
  
  RESULTS
  Procedures of 246,316 were identified, of which 25% met criteria for AP. Eighty-two percent of the children received antibiotics during procedures when AP was indicated (range, 60%-96% by hospital), and 40% of the patients received antibiotics when there was no indication (range, 10%-83%). The likelihood of receiving AP was significantly different between hospitals for all procedures examined (P < .0001 for each procedure). Adverse events were significantly more frequent in children receiving AP than in those who did not (odds ratio [95% confidence interval] C difficile: 18.8 [6.9-51.5], P < .0001; epinephrine: 1.8 [1.7-2.0], P < .0001; diphenhydramine: 6.0 [5.6-6.5], P < .0001).
  
  
  CONCLUSIONS
  Significant variation exists in the use of AP in the pediatric surgical population. Many children do not receive AP when indicated, and an even greater proportion may receive antibiotics when there is no indication. These findings may have profound implications from a public health perspective when extrapolated to all children undergoing surgical procedures.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Boston-Harvard Medical School, Boston, MA 02115, USA. shawn.rangel@childrens.harvard.edu
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.forename: Monica
authors.initials: M
authors.lastname: Fung
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.forename: Lin
authors.initials: L
authors.lastname: Ma
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Nelson
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Sandora
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000592:standards / Q000639:trends*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000639:trends; D005260:Female; D013502:General Surgery / Q000379:methods* / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000379:methods* / Q000592:standards; D059035:Perioperative Period / Q000379:methods; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013520:Urologic Surgical Procedures / Q000379:methods / Q000592:standards
chemical_list: D000900:Anti-Bacterial Agents