Surgical antimicrobial prophylaxis among paediatric patients in South Africa comparing two healthcare settings

Nicolene van der Sandt, Natalie Schellack, Lindi A Mabope, Mothahadini PB Mawela, Danie Kruger, Brian Godman

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: Appropriate use of surgical antimicrobial prophylaxis (SAP) is a concern in view of its impact on morbidity, mortality and costs. Little is currently known about SAP in South Africa. OBJECTIVE: To assess compliance to SAP guidelines for pediatric patients undergoing surgery in 1 of 4 surgical subspecialties among hospitals in South Africa. METHODS: An eight-month retrospective chart review in both a teaching hospital and a private hospital between February and August 2015. Prescriptions of antimicrobials as SAP were compared with current SAP Guidelines, consolidated from a literature review, regarding 5 criteria-appropriate antimicrobial selection, dosing, timing of administration, redosing and duration of treatment. RESULTS: We reviewed 224 charts, 112 from each hospital type. The majority (P = 1.000) of patients received SAP when indicated (77.3% and 100.0%, respectively, from the teaching and private hospitals). A noteworthy 21.1% and 45.9% of patients received antimicrobials without an indication, respectively, from teaching and private hospitals. Compliance to all 5 of the criteria was not met by either hospital type. Overall, the teaching hospital met the most criteria (3 out of 5) in 58.8% of situations. CONCLUSIONS: Current SAP practices in South Africa's teaching and private hospitals diverge from current SAP Guidelines. Inappropriate overuse of SAP occurs in both hospital sectors, while underuse was found in the teaching hospital. Full compliance to the 5 criteria was not met by either hospital. Noncompliance was largely attributed to inappropriate selection and dosing. Quality improvement interventions, continued surveillance and local standardized evidence-based SAP Guidelines are needed to improve care. This is already happening.

LanguageEnglish
Pages122-126
Number of pages5
JournalThe Pediatric Infectious Disease Journal
Volume38
Issue number2
Early online date19 Apr 2018
DOIs
Publication statusPublished - 28 Feb 2019

Fingerprint

South Africa
Teaching Hospitals
Private Hospitals
Pediatrics
Delivery of Health Care
Guidelines
Quality Improvement
Compliance
Prescriptions
Morbidity
Costs and Cost Analysis
Mortality

Keywords

  • surgical antimicrobial prophylaxis
  • paediatrics
  • South African healthcare

Cite this

van der Sandt, Nicolene ; Schellack, Natalie ; Mabope, Lindi A ; Mawela, Mothahadini PB ; Kruger, Danie ; Godman, Brian. / Surgical antimicrobial prophylaxis among paediatric patients in South Africa comparing two healthcare settings. 2019 ; Vol. 38, No. 2. pp. 122-126.
@article{52b75c5761994c9fbc2885f4953fdbf4,
title = "Surgical antimicrobial prophylaxis among paediatric patients in South Africa comparing two healthcare settings",
abstract = "BACKGROUND: Appropriate use of surgical antimicrobial prophylaxis (SAP) is a concern in view of its impact on morbidity, mortality and costs. Little is currently known about SAP in South Africa. OBJECTIVE: To assess compliance to SAP guidelines for pediatric patients undergoing surgery in 1 of 4 surgical subspecialties among hospitals in South Africa. METHODS: An eight-month retrospective chart review in both a teaching hospital and a private hospital between February and August 2015. Prescriptions of antimicrobials as SAP were compared with current SAP Guidelines, consolidated from a literature review, regarding 5 criteria-appropriate antimicrobial selection, dosing, timing of administration, redosing and duration of treatment. RESULTS: We reviewed 224 charts, 112 from each hospital type. The majority (P = 1.000) of patients received SAP when indicated (77.3{\%} and 100.0{\%}, respectively, from the teaching and private hospitals). A noteworthy 21.1{\%} and 45.9{\%} of patients received antimicrobials without an indication, respectively, from teaching and private hospitals. Compliance to all 5 of the criteria was not met by either hospital type. Overall, the teaching hospital met the most criteria (3 out of 5) in 58.8{\%} of situations. CONCLUSIONS: Current SAP practices in South Africa's teaching and private hospitals diverge from current SAP Guidelines. Inappropriate overuse of SAP occurs in both hospital sectors, while underuse was found in the teaching hospital. Full compliance to the 5 criteria was not met by either hospital. Noncompliance was largely attributed to inappropriate selection and dosing. Quality improvement interventions, continued surveillance and local standardized evidence-based SAP Guidelines are needed to improve care. This is already happening.",
keywords = "surgical antimicrobial prophylaxis, paediatrics, South African healthcare",
author = "{van der Sandt}, Nicolene and Natalie Schellack and Mabope, {Lindi A} and Mawela, {Mothahadini PB} and Danie Kruger and Brian Godman",
year = "2019",
month = "2",
day = "28",
doi = "10.1097/INF.0000000000002072",
language = "English",
volume = "38",
pages = "122--126",
number = "2",

}

Surgical antimicrobial prophylaxis among paediatric patients in South Africa comparing two healthcare settings. / van der Sandt, Nicolene; Schellack, Natalie; Mabope, Lindi A; Mawela, Mothahadini PB ; Kruger, Danie; Godman, Brian.

Vol. 38, No. 2, 28.02.2019, p. 122-126.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Surgical antimicrobial prophylaxis among paediatric patients in South Africa comparing two healthcare settings

AU - van der Sandt, Nicolene

AU - Schellack, Natalie

AU - Mabope, Lindi A

AU - Mawela, Mothahadini PB

AU - Kruger, Danie

AU - Godman, Brian

PY - 2019/2/28

Y1 - 2019/2/28

N2 - BACKGROUND: Appropriate use of surgical antimicrobial prophylaxis (SAP) is a concern in view of its impact on morbidity, mortality and costs. Little is currently known about SAP in South Africa. OBJECTIVE: To assess compliance to SAP guidelines for pediatric patients undergoing surgery in 1 of 4 surgical subspecialties among hospitals in South Africa. METHODS: An eight-month retrospective chart review in both a teaching hospital and a private hospital between February and August 2015. Prescriptions of antimicrobials as SAP were compared with current SAP Guidelines, consolidated from a literature review, regarding 5 criteria-appropriate antimicrobial selection, dosing, timing of administration, redosing and duration of treatment. RESULTS: We reviewed 224 charts, 112 from each hospital type. The majority (P = 1.000) of patients received SAP when indicated (77.3% and 100.0%, respectively, from the teaching and private hospitals). A noteworthy 21.1% and 45.9% of patients received antimicrobials without an indication, respectively, from teaching and private hospitals. Compliance to all 5 of the criteria was not met by either hospital type. Overall, the teaching hospital met the most criteria (3 out of 5) in 58.8% of situations. CONCLUSIONS: Current SAP practices in South Africa's teaching and private hospitals diverge from current SAP Guidelines. Inappropriate overuse of SAP occurs in both hospital sectors, while underuse was found in the teaching hospital. Full compliance to the 5 criteria was not met by either hospital. Noncompliance was largely attributed to inappropriate selection and dosing. Quality improvement interventions, continued surveillance and local standardized evidence-based SAP Guidelines are needed to improve care. This is already happening.

AB - BACKGROUND: Appropriate use of surgical antimicrobial prophylaxis (SAP) is a concern in view of its impact on morbidity, mortality and costs. Little is currently known about SAP in South Africa. OBJECTIVE: To assess compliance to SAP guidelines for pediatric patients undergoing surgery in 1 of 4 surgical subspecialties among hospitals in South Africa. METHODS: An eight-month retrospective chart review in both a teaching hospital and a private hospital between February and August 2015. Prescriptions of antimicrobials as SAP were compared with current SAP Guidelines, consolidated from a literature review, regarding 5 criteria-appropriate antimicrobial selection, dosing, timing of administration, redosing and duration of treatment. RESULTS: We reviewed 224 charts, 112 from each hospital type. The majority (P = 1.000) of patients received SAP when indicated (77.3% and 100.0%, respectively, from the teaching and private hospitals). A noteworthy 21.1% and 45.9% of patients received antimicrobials without an indication, respectively, from teaching and private hospitals. Compliance to all 5 of the criteria was not met by either hospital type. Overall, the teaching hospital met the most criteria (3 out of 5) in 58.8% of situations. CONCLUSIONS: Current SAP practices in South Africa's teaching and private hospitals diverge from current SAP Guidelines. Inappropriate overuse of SAP occurs in both hospital sectors, while underuse was found in the teaching hospital. Full compliance to the 5 criteria was not met by either hospital. Noncompliance was largely attributed to inappropriate selection and dosing. Quality improvement interventions, continued surveillance and local standardized evidence-based SAP Guidelines are needed to improve care. This is already happening.

KW - surgical antimicrobial prophylaxis

KW - paediatrics

KW - South African healthcare

UR - https://journals.lww.com/pidj/pages/default.aspx

U2 - 10.1097/INF.0000000000002072

DO - 10.1097/INF.0000000000002072

M3 - Article

VL - 38

SP - 122

EP - 126

IS - 2

ER -