Analysis of antibiotic surgical prophylaxis in hospitalized children suffering upper and lower extremity injuries

Background Surgical prophylaxis may account for one-third of all antibiotic use in paediatric hospitals. Objective To evaluate the appropriateness of surgical prophylaxis and to analyse adherence of surgeons to surgical prophylaxis guidelines. Method Retrospective study at a university paediatric hospital. Patients younger than 18 years with injuries of lower and upper extremities were included. The study period was from January 1st 2011–December 31st 2013 and January 1st 2001–December 31st 2003. The appropriateness of the antibiotic use was analysed in accordance with international and local guidelines. Results Antibiotic prophylaxis was needed by 1125 (55.0 %) patients in 2011–2013 and by 816 (44.4 %) patients in 2001–2003. However, it was administered to only 66.0 % of those in need of prophylaxis in 2011–2013 and to 70.8 % of those in 2001–2003. A single antibiotic dose was administered to 73.8 % of those who received antibiotics in 2011–2013 and to 34.1 % of those in 2001–2003. The timing of the first dose was correct in 370 (52.9 %) prescriptions in 2011–2013 and in 10 (20.4 %) prescriptions in 2001–2003. The most often used antibiotics for prophylaxis were cefazolin in 2011–2013 and cefuroxime in 2001–2003. Conclusion Overall adherence rate to the international and hospital guidelines was low, indicating that in order to improve this situation, there is a need for multiple interventions.