Cargando…

1361. Variation in Perioperative Antibiotic Use for Children Undergoing Congenital Heart Disease Surgery in U.S. Academically Affiliated Centers

BACKGROUND: Perioperative antibiotics (PA) are routinely given to children undergoing congenital heart disease (CHD) surgery to prevent surgical site infection. National guidelines recommend narrow-spectrum PA (such as Cefazolin) for most CHD procedures. However, indications for broad-spectrum PA ar...

Descripción completa

Detalles Bibliográficos
Autores principales: Cooch, Peter B, Wattier, Rachel, Steurer-Muller, Martina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777211/
http://dx.doi.org/10.1093/ofid/ofaa439.1543
_version_ 1783630849638400000
author Cooch, Peter B
Wattier, Rachel
Steurer-Muller, Martina
author_facet Cooch, Peter B
Wattier, Rachel
Steurer-Muller, Martina
author_sort Cooch, Peter B
collection PubMed
description BACKGROUND: Perioperative antibiotics (PA) are routinely given to children undergoing congenital heart disease (CHD) surgery to prevent surgical site infection. National guidelines recommend narrow-spectrum PA (such as Cefazolin) for most CHD procedures. However, indications for broad-spectrum PA are not well established, and limited literature suggests high exposure to broad-spectrum PA in this population. We performed a contemporary, multicenter description of prevalence and variability of broad-spectrum PA exposure within the pediatric CHD surgical population. METHODS: We identified children 0-17 years admitted to U.S. academically-affiliated centers participating in the Vizient Clinical Database/Resource Manager from 2011-2018. Patients who had ICD-9 and ICD-10 codes indicating a CHD surgical procedure with intravenous antibiotics initiated the day of surgery were eligible for inclusion. Antibiotics broader than first- and second-generation cephalosporins were designated broad-spectrum. We excluded centers with 5 or fewer annual procedures. We excluded patients undergoing heart transplant, concurrent non-cardiac procedures, and those with missing medication data. RESULTS: 19,152 hospital admissions from 24 centers met inclusion criteria. 55% of patients were male, 18% were under 30 days of age at time of surgery, and 5.1% had diagnosis codes for prematurity. Broad spectrum antibiotics were administered in 21.4% of CHD procedures during the study period. Between the 24 centers, the proportion of surgical cases given broad-spectrum PA ranged from 1.5% to 95%, which was unrelated to center annual surgical volume. Children under 30 days of age and those with prematurity were significantly more likely to receive broad-spectrum agents. Vancomycin was the primary antibiotic contributing to broad-spectrum PA exposure. CONCLUSION: Substantial variation in broad-spectrum PA use was observed among children undergoing congenital heart disease surgery in academically affiliated United States centers from 2011-2018. Neonates and premature infants have the highest rates of exposure to broad-spectrum antibiotics. Standardization of perioperative antibiotics in CHD surgery is a potential intervention to limit antibiotic exposure in young infants. DISCLOSURES: All Authors: No reported disclosures
format Online
Article
Text
id pubmed-7777211
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-77772112021-01-07 1361. Variation in Perioperative Antibiotic Use for Children Undergoing Congenital Heart Disease Surgery in U.S. Academically Affiliated Centers Cooch, Peter B Wattier, Rachel Steurer-Muller, Martina Open Forum Infect Dis Poster Abstracts BACKGROUND: Perioperative antibiotics (PA) are routinely given to children undergoing congenital heart disease (CHD) surgery to prevent surgical site infection. National guidelines recommend narrow-spectrum PA (such as Cefazolin) for most CHD procedures. However, indications for broad-spectrum PA are not well established, and limited literature suggests high exposure to broad-spectrum PA in this population. We performed a contemporary, multicenter description of prevalence and variability of broad-spectrum PA exposure within the pediatric CHD surgical population. METHODS: We identified children 0-17 years admitted to U.S. academically-affiliated centers participating in the Vizient Clinical Database/Resource Manager from 2011-2018. Patients who had ICD-9 and ICD-10 codes indicating a CHD surgical procedure with intravenous antibiotics initiated the day of surgery were eligible for inclusion. Antibiotics broader than first- and second-generation cephalosporins were designated broad-spectrum. We excluded centers with 5 or fewer annual procedures. We excluded patients undergoing heart transplant, concurrent non-cardiac procedures, and those with missing medication data. RESULTS: 19,152 hospital admissions from 24 centers met inclusion criteria. 55% of patients were male, 18% were under 30 days of age at time of surgery, and 5.1% had diagnosis codes for prematurity. Broad spectrum antibiotics were administered in 21.4% of CHD procedures during the study period. Between the 24 centers, the proportion of surgical cases given broad-spectrum PA ranged from 1.5% to 95%, which was unrelated to center annual surgical volume. Children under 30 days of age and those with prematurity were significantly more likely to receive broad-spectrum agents. Vancomycin was the primary antibiotic contributing to broad-spectrum PA exposure. CONCLUSION: Substantial variation in broad-spectrum PA use was observed among children undergoing congenital heart disease surgery in academically affiliated United States centers from 2011-2018. Neonates and premature infants have the highest rates of exposure to broad-spectrum antibiotics. Standardization of perioperative antibiotics in CHD surgery is a potential intervention to limit antibiotic exposure in young infants. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7777211/ http://dx.doi.org/10.1093/ofid/ofaa439.1543 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Cooch, Peter B
Wattier, Rachel
Steurer-Muller, Martina
1361. Variation in Perioperative Antibiotic Use for Children Undergoing Congenital Heart Disease Surgery in U.S. Academically Affiliated Centers
title 1361. Variation in Perioperative Antibiotic Use for Children Undergoing Congenital Heart Disease Surgery in U.S. Academically Affiliated Centers
title_full 1361. Variation in Perioperative Antibiotic Use for Children Undergoing Congenital Heart Disease Surgery in U.S. Academically Affiliated Centers
title_fullStr 1361. Variation in Perioperative Antibiotic Use for Children Undergoing Congenital Heart Disease Surgery in U.S. Academically Affiliated Centers
title_full_unstemmed 1361. Variation in Perioperative Antibiotic Use for Children Undergoing Congenital Heart Disease Surgery in U.S. Academically Affiliated Centers
title_short 1361. Variation in Perioperative Antibiotic Use for Children Undergoing Congenital Heart Disease Surgery in U.S. Academically Affiliated Centers
title_sort 1361. variation in perioperative antibiotic use for children undergoing congenital heart disease surgery in u.s. academically affiliated centers
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777211/
http://dx.doi.org/10.1093/ofid/ofaa439.1543
work_keys_str_mv AT coochpeterb 1361variationinperioperativeantibioticuseforchildrenundergoingcongenitalheartdiseasesurgeryinusacademicallyaffiliatedcenters
AT wattierrachel 1361variationinperioperativeantibioticuseforchildrenundergoingcongenitalheartdiseasesurgeryinusacademicallyaffiliatedcenters
AT steurermullermartina 1361variationinperioperativeantibioticuseforchildrenundergoingcongenitalheartdiseasesurgeryinusacademicallyaffiliatedcenters