Institutional members access full text with Ovid®

Share this article on:

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

van der Sandt, Nicolene, MPharm1; Schellack, Natalie, PhD1; Mabope, Lindi, A., PhD (Pharm)2; Mawela, Mothahadini, PB, MMed3; Kruger, Danie, MSc1,4; Godman, Brian, PhD5,6,7

The Pediatric Infectious Disease Journal: April 19, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/INF.0000000000002072
Antimicrobial Reports: PDF Only

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: Assess compliance to SAP guidelines for pediatric patients undergoing surgery in one of four surgical sub-specialties among hospitals in South Africa.

Methods: Eight month retrospective chart review in both a teaching hospital and a private hospital between February and August 2015. Prescriptions of antimicrobials as SAP was compared to current SAP Guidelines, consolidated from a literature review, regarding 5 criteria - appropriate antimicrobial selection, dosing, timing of administration, redosing and duration of treatment.

Results: 224 charts we reviewed, 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 hospital). A noteworthy 21.1% and 45.9% of patients received antimicrobials without an indication, respectively, from teaching and private hospitals. Compliance to all five of the criteria was not met by either hospital type. Overall, the teaching hospital met the most criteria (three out of five) in 58.8% of situations.

Conclusion: 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, whilst underuse was found in the teaching hospital. Full compliance to the five criteria was not met by either hospital. Non-compliance 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.

1Department of Pharmacy, Sefako Makgatho Health Sciences University, South Africa. Email: nicolene.vdsandt@gmail.com, natalie.schellack@smu.ac.za

2Department of Medicine, Sefako Makgatho Health Sciences University, South Africa. Email: lindi.zikalala@smu.ac.za

3Department of Paediatrics and Child Health, Sefako Makgatho Health Sciences University, South Africa. Email: john.child@smu.ac.za, Pharmacy, Private Hospital, Pretoria, South Africa. Email: Danie.Kruger@smu.ac.sa

4Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK. Email: brian.godman@strath.ac.uk

5Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden. Email: Brian.Godman@ki.se

6Health Economics Centre, Liverpool University Management School, Liverpool, United Kingdom. Email: Brian.Godman@liverpool.ac.uk

Funding and Conflicts of Interest: 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.

Correspondence: Brian Godman, PhD, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom. Email: Brian.godman@strath.ac.uk. Telephone: 0141 548 3825. Fax: 0141 552 2562 and Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden. Email: Brian.Godman@ki.se. Telephone + 46 8 58581068. Fax + 46 8 59581070

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.