An Antimicrobial Stewardship Intervention Program in Pediatric Surgery
试验速览
- 阶段
- 不适用
- 状态
- 撤回
- 主要终点
- Compliance with American Pediatric Surgical Association recommendations for postoperative antibiotics for appendicitis
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- — 至 18 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •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.
排除标准
- •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
结局指标
主要结局
Compliance with American Pediatric Surgical Association recommendations for postoperative antibiotics for appendicitis
时间窗: 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
次要结局
- Postoperative intravenous antibiotics for non-perforated appendicitis(From date of admission until first follow-up visit, typically within 4-6 weeks of discharge)
- Postoperative oral antibiotics for non-perforated appendicitis(From date of admission until first follow-up visit, typically within 4-6 weeks of discharge)
研究者
Dr Anna Shawyer
Dr. Anna Shawyer
Alberta Children's Hospital