Antimicrobial Stewardship in Pediatric Surgery (AbxPS)
perjantai 16. maaliskuuta 2018 päivittänyt: 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.
Tutkimuksen yleiskatsaus
Tila
Peruutettu
Ehdot
Interventio / Hoito
Yksityiskohtainen kuvaus
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.
Opintotyyppi
Havainnollistava
Osallistumiskriteerit
Tutkijat etsivät ihmisiä, jotka sopivat tiettyyn kuvaukseen, jota kutsutaan kelpoisuuskriteereiksi. Joitakin esimerkkejä näistä kriteereistä ovat henkilön yleinen terveydentila tai aiemmat hoidot.
Kelpoisuusvaatimukset
Opintokelpoiset iät
Ei vanhempi kuin 18 vuotta (Lapsi, Aikuinen)
Hyväksyy terveitä vapaaehtoisia
Joo
Sukupuolet, jotka voivat opiskella
Kaikki
Näytteenottomenetelmä
Todennäköisyysnäyte
Tutkimusväestö
The study population is the pediatric surgeons at our institution who will have their antibiotic prescribing audited.
Kuvaus
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
Opintosuunnitelma
Tässä osiossa on tietoja tutkimussuunnitelmasta, mukaan lukien kuinka tutkimus on suunniteltu ja mitä tutkimuksella mitataan.
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
Kohortit ja interventiot
Ryhmä/Kohortti |
Interventio / Hoito |
|---|---|
|
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.
|
Twice weekly meeting with Infectious Disease and Pediatric Surgery team members to audit antibiotics prescribed and suggest role for discontinuation.
|
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Compliance with American Pediatric Surgical Association recommendations for postoperative antibiotics for appendicitis
Aikaikkuna: 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
|
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Postoperative intravenous antibiotics for non-perforated appendicitis
Aikaikkuna: 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
Aikaikkuna: 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
|
Muut tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Postoperative fever
Aikaikkuna: 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
Aikaikkuna: 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)
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: Length of admission
|
Measured in days (from date of admission until date of discharge)
|
Length of admission
|
|
Adverse reaction to antibiotic
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
|
Yhteistyökumppanit ja tutkijat
Täältä löydät tähän tutkimukseen osallistuvat ihmiset ja organisaatiot.
Sponsori
Tutkijat
- Päätutkija: Anna Shawyer, MS, MSc, Alberta Children's Hospital
Julkaisuja ja hyödyllisiä linkkejä
Tutkimusta koskevien tietojen syöttämisestä vastaava henkilö toimittaa nämä julkaisut vapaaehtoisesti. Nämä voivat koskea mitä tahansa tutkimukseen liittyvää.
Yleiset julkaisut
- St Peter SD, Sharp SW, Holcomb GW 3rd, Ostlie DJ. An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg. 2008 Dec;43(12):2242-5. doi: 10.1016/j.jpedsurg.2008.08.051.
- Lee SL, Islam S, Cassidy LD, Abdullah F, Arca MJ; 2010 American Pediatric Surgical Association Outcomes and Clinical Trials Committee. Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg. 2010 Nov;45(11):2181-5. doi: 10.1016/j.jpedsurg.2010.06.038.
- Srigley JA, Brooks A, Sung M, Yamamura D, Haider S, Mertz D. Inappropriate use of antibiotics and Clostridium difficile infection. Am J Infect Control. 2013 Nov;41(11):1116-8. doi: 10.1016/j.ajic.2013.04.017. Epub 2013 Aug 7.
- Rangel SJ, Fung M, Graham DA, Ma L, Nelson CP, Sandora TJ. Recent trends in the use of antibiotic prophylaxis in pediatric surgery. J Pediatr Surg. 2011 Feb;46(2):366-71. doi: 10.1016/j.jpedsurg.2010.11.016.
- Ghaleb MA, Barber N, Franklin BD, Wong IC. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child. 2010 Feb;95(2):113-8. doi: 10.1136/adc.2009.158485. Epub 2010 Feb 4.
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Muita asiaankuuluvia MeSH-ehtoja
Muut tutkimustunnusnumerot
- ACH PedSurg ACS 002
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