Antimicrobial Stewardship in Pediatric Surgery (AbxPS)

March 16, 2018 updated by: Dr Anna Shawyer, Alberta Children's Hospital

An Antimicrobial Stewardship Intervention Program in Pediatric Surgery

Acute appendicitis is a common surgical emergency in children. Non-perforated appendicitis patients do not require antibiotics after appendectomy. Although guidelines and recommendations exist to decrease post-operative antibiotic mis-use after appendectomy, surgeons continue to prescribe unwarranted antibiotics.

The aim of this study is to determine if an Antimicrobial Stewardship Program in Pediatric Surgery will decrease the use of un-warranted antibiotics.

Study Overview

Status

Withdrawn

Conditions

Intervention / Treatment

Detailed Description

Many surgeons continue to treat non-perforated or "borderline perforated" appendicitis with postoperative antibiotics despite an evidence-based definition of perforation (in the pediatric surgical literature) and many guidelines and recommendations that specify that no postoperative antibiotics are required. Children with perforated appendicitis are also often treated with longer-than-necessary courses of antibiotics. Although surgeons may feel that they only prescribe additional doses on occasion, evidence suggests that this behavior occurs in over 50% of children with non-perforated appendicitis.

These additional doses contribute to a longer length of stay, excess costs to the health care system, and disrupt patient flow. Additionally, the patients are exposed to more antibiotics and their potential for adverse effects (such as incorrect dose, incorrect medication, allergic reaction, antimicrobial resistance or c difficile infection).

Antimicrobial stewardship programs have been successful in pediatrics and adult general surgery in curbing unwarranted antibiotic use, but have never been evaluated in pediatric general surgery.

Study Type

Observational

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

No older than 18 years (Child, Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Sampling Method

Probability Sample

Study Population

The study population is the pediatric surgeons at our institution who will have their antibiotic prescribing audited.

Description

Inclusion Criteria:

  • Participant (surgeon) is a pediatric surgeon at McMaster Children's Hospital and takes care of patients under the age of 18 who undergo appendectomy.
  • Participant (surgeon) is able to read, write and understand English.
  • Participant (surgeon) is able to provide informed consent.

Exclusion Criteria:

  • Participant (surgeon) only has patients who undergo drain insertion, PICC line insertion or a secondary operation during the same admission
  • Participant (surgeon) only has patients who do not undergo operation (i.e. "conservative management with interval appendectomy)
  • Participant (surgeon) does not provide informed consent
  • Participant (surgeon) does not understand written and spoken English diagnosis other than appendicitis at time of operation

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
NO Antimicrobial Stewardship Program
Prospective cohort of children who undergo appendectomy for acute appendicitis (perforated and non-perforated) BEFORE the implementation of the Antimicrobial Stewardship Program.
WITH Antimicrobial Stewardship Program
Prospective cohort of children who undergo appendectomy for acute appendicitis (perforated and non-perforated) WITH the implementation of the Antimicrobial Stewardship Program.
Other: Antimicrobial Stewardship Program
Twice weekly meeting with Infectious Disease and Pediatric Surgery team members to audit antibiotics prescribed and suggest role for discontinuation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Compliance with American Pediatric Surgical Association recommendations for postoperative antibiotics for appendicitis
Time Frame: From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Includes both intravenous and oral antibiotics prescribed, both during the time frame from admission until discharge, in addition to any prescription given for home, oral antibiotics. Measured as yes/no
From date of admission until first follow-up visit, typically within 4-6 weeks of discharge

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Postoperative intravenous antibiotics for non-perforated appendicitis
Time Frame: From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
measured as number of days (ie number of doses divided by number of doses-per-day)
From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Postoperative oral antibiotics for non-perforated appendicitis
Time Frame: From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
measured as number of days (ie number of doses divided by number of doses-per-day)
From date of admission until first follow-up visit, typically within 4-6 weeks of discharge

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Postoperative fever
Time Frame: Length of admission
Rectal temperature above 100.4ºF (38ºC), measured as yes/no and on what postoperative day Oral temperature above 100ºF (37.8ºC) Axillary (armpit) temperature above 99ºF (37.2ºC) Ear (tympanic membrane) temperature above 100.4ºF (38ºC) in rectal mode or 99.5ºF (37.5ºC) in oral mode Forehead (temporal artery) temperature above 100.4ºF (38ºC)
Length of admission
Readmission within 30 days
Time Frame: Within 30 days of discharge
Need for readmission within 30 days of discharge, measured as yes/no
Within 30 days of discharge
Peripherally inserted intravenous catheter (PICC)
Time Frame: From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Need for PICC insertion for long term antibiotics, intravenous fluids or parenteral nutrition, measured as yes/no
From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Drain insertion
Time Frame: From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Need for a drain insertion (by interventional radiology) for postoperative abscess, measured as yes/no
From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Re-operation
Time Frame: From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Need for re-operation on the same admission, measured as yes/no
From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Length of Stay
Time Frame: Length of admission
Measured in days (from date of admission until date of discharge)
Length of admission
Adverse reaction to antibiotic
Time Frame: From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Measured as yes/no in addition to description of reaction (eg hives, shortness of breath)
From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Wrong medication/Wrong dose
Time Frame: From date of admission until date of first follow-up visit, typically within 4-6 weeks of discharge
Measured as yes/no in addition to description of problem (wrong dose, wrong medication)
From date of admission until date of first follow-up visit, typically within 4-6 weeks of discharge
C difficile infection
Time Frame: From date of admission until first follow-up visit, typically within 4-6 weeks of discharge
Measured as yes/no based on stool assay
From date of admission until first follow-up visit, typically within 4-6 weeks of discharge

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Alberta Children's Hospital

Investigators

  • Principal Investigator: Anna Shawyer, MS, MSc, Alberta Children's Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

January 1, 2015

Primary Completion (Anticipated)

December 1, 2015

Study Completion (Anticipated)

December 1, 2015

Study Registration Dates

First Submitted

October 8, 2014

First Submitted That Met QC Criteria

October 21, 2014

First Posted (Estimate)

October 22, 2014

Study Record Updates

Last Update Posted (Actual)

March 20, 2018

Last Update Submitted That Met QC Criteria

March 16, 2018

Last Verified

March 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ACH PedSurg ACS 002

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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