Decreasing Surgical Site Infections in Pediatric Stoma Closures
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Read the article on jpedsurg.org ↗Article · Nov 2019 · 1 min read
In brief
In brief
Quality improvement study demonstrating dramatic reduction in surgical site infections after pediatric stoma closures through targeted antibiotic prophylaxis. By switching from cefoxitin to ampicillin-sulbactam based on local wound culture data showing enterococcus prevalence, SSI rates dropped from 21.4% to 2.2% over four years.
Written by the GCMD Library team from the article.
Introduction
Gastrointestinal (GI) operations represent a significant proportion of the surgical site infection (SSI) burden in pediatric patients, resulting in significant morbidity. We have previously demonstrated that a GI bundle decreases SSI rates, length of stay (LOS), and hospital charges. Following this success, we hypothesized that by targeting the preoperative antibiotics for stoma closures based on organisms found in infected wounds, we could further decrease SSI rates.
Methods
As part of a broad quality improvement effort to reduce SSI rates, we reviewed the responsible pathogens and their sensitivities as well as the preoperative antibiotic used, and found that 15% of wound infections were caused by enterococcus. Based on this information, starting in April 2017, we changed the prior preoperative antibiotic cefoxitin to ampicillin-sulbactam, which more accurately targeted the prevalent pathogens from April 2017 to October 2018.
Results
The baseline SSI rate for all stoma takedown patients was 21.4% (25 of 119). After bundle implementation, this decreased to 7.9% (17 of 221; p = 0.03) over a period of 2.5 years. Then, after changing the preoperative antibiotics, our rate of SSI decreased further to 2.2% (1 of 44; p = 0.039) over a period of 1.5 years.
Conclusion
Significant reduction of SSI in GI surgery can be accomplished with several prevention strategies (our GI bundle). Then a change of the preoperative antibiotic choice, chosen based on causative wound infection organisms, may further decrease SSI rates. We recommend an institution specific analysis of wound infections and modification of preoperative antibiotics if the responsible organisms are resistant to the original antibiotic choice.
Type of study
Retrospective cohort study.
Level of evidence
Level III.