title: Surgical antibiotic prophylaxis in children: adherence to indication, choice of agent, timing, and duration.
abstract: OBJECTIVE
  Surgical antibiotic prophylaxis (SAP) in children is poorly characterized. We investigated SAP for children undergoing elective surgical procedures.
  
  
  METHODS
  We prospectively investigated elective surgical procedures performed in children <18 years, from November 2012 to February 2013, in three tertiary-care children's hospitals in Italy. Data were derived from clinical records. Antibiotics were considered prophylactic if given by parenteral route during the same day of the procedure. SAP indication was defined according to international guidelines. Whenever SAP was indicated, it was defined appropriate if antibiotic choice was different from third-/fourth-generation cephalosporins, carbapenems, or piperacillin/tazobactam; timing of first dose was within 60 min before incision; and duration of administration was ≤24 h. Multivariable logistic regression model was used to assess independent predictors of adherence to SAP administration, for procedures with SAP indication performed in all hospitals.
  
  
  RESULTS
  Data on 765 procedures were collected. SAP was administered in 81% of 206 procedures with SAP indication and in 18% of 559 procedures with no indication. Type of procedure and hospital were significantly associated with adherence of administration to SAP indication. In the 206 procedures where SAP was indicated, overall appropriateness of antibiotic choice, timing, and duration was 8%.
  
  
  CONCLUSIONS
  The SAP rate observed in procedures with SAP indication and the appropriateness of drug choice, timing, and duration are reasons of concern. Quality improvement interventions for implementing SAP recommendations in children are strongly needed, and their impact should be evaluated at hospital level.
authors.affiliation: Clinical Epidemiology Unit, Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy, marta.ciofidegliatti@opbg.net.
authors.forename: Marta
authors.initials: M
authors.lastname: Ciofi degli Atti
authors.forename: Stefania
authors.initials: S
authors.lastname: Spila Alegiani
authors.forename: Roberto
authors.initials: R
authors.lastname: Raschetti
authors.forename: Pasquale
authors.initials: P
authors.lastname: Arace
authors.forename: Angela
authors.initials: A
authors.lastname: Giusti
authors.forename: Raffaele
authors.initials: R
authors.lastname: Spiazzi
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Raponi
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior / Q000502:physiology; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006761:Hospitals; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin