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Surgical Antimicrobial Prophylaxis Among Pediatric Patients in South Africa Comparing Two Healthcare Settings

van der Sandt, Nicolene, MPharm*; Schellack, Natalie, PhD*; Mabope, Lindi A., MSc, Med; Mawela, Mothahadini P.B., MMed; Kruger, Danie, MSc*,§; Godman, Brian, PhD¶,‖,*

The Pediatric Infectious Disease Journal: February 2019 - Volume 38 - Issue 2 - p 122–126
doi: 10.1097/INF.0000000000002072
Antimicrobial Reports
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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.

From the *Department of Pharmacy

Department of Medicine, Sefako Makgatho Health Sciences University, South Africa

Department of Paediatrics and Child Health, Sefako Makgatho Health Sciences University, South Africa and Pharmacy

§Private Hospital, Pretoria, South Africa; Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom

Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden

Health Economics Centre, Liverpool University Management School, Liverpool, United Kingdom.

Accepted for publication March 8, 2018.

There was no grant for this project although Sefako Makgatho Health Sciences University paid for the printing of the data collection tools.

The authors declare they have no conflicts of interest to declare.

Address for correspondence: Brian Godman, PhD, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom. E-mail: Brian.godman@strath.ac.uk and Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden. E-mail: Brian.Godman@ki.se.

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