Understanding antibiotic prophylaxis prescribing in pediatric surgical specialties.
Understanding antibiotic prophylaxis prescribing in pediatric surgical specialties.
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DOI：
10.1017/ice.2020.71
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发表时间：
2020-06
影响因子：
4.5
通讯作者：
McKay VR
中科院分区：
文献类型：
--
作者：
Malone SM;Seigel NS;Newland JG;Saito JM;McKay VR
过度使用抗生素导致继发性不良结局，并导致目前抗生素耐药性感染的发生率，构成公共卫生危机。在小儿外科专科，儿童继续接受不必要的抗生素。了解影响小儿外科医生决定围手术期预防性使用抗生素的因素。焦点小组包括以下专业的儿科手术师/外科医生：介入心脏病学、耳鼻喉科、骨科、心胸外科和普外科。共有23名中位经验为9年（范围：0.5-29年）的外科医生参加了焦点小组，每个小组持续30-90分钟。出现了五个影响抗生素处方实践信念的主题：（1）依赖以前的经验和早期教育，（2）平衡抗生素使用与感染风险，（3）对科学证据状态的不确定性，（4）理解沟通和团队合作的重要性，以及（5）医院层面的普遍关注。外科医生描述了一组复杂的因素，影响他们在儿科手术病例中的抗生素处方。他们报告了最初的，但不是正在进行的，培训和使用个人的风险和利益的权重作为处方实践的主要独裁者。抗菌药物管理计划应与外科医生合作，制定可接受的实施策略，以优化抗生素处方。
Overuse of antibiotics has caused secondary poor outcomes and has led to a current rate of antibiotic resistant infections that constitutes a public health crisis. In pediatric surgical specialties, children continue to receive unnecessary antibiotics. To understand the factors that contribute to pediatric surgeons’ decisions regarding the use of perioperative antibiotic prophylaxis. Focus groups included pediatric proceduralists/surgeons from the following specialties: interventional cardiology, otolaryngology, orthopedic surgery, cardiothoracic surgery, and general surgery. A total of 23 surgeons with a median of 9 years of experience (range, 0.5–29 years) participated in the focus groups that lasted 30–90 minutes each. Five themes emerged influencing beliefs about antibiotic prescribing practices: (1) reliance on previous experience and early education, (2) balancing antibiotic use with risk of infection, (3) uncertainty about the state of the scientific evidence, (4) understanding importance of communication and team collaboration, and (5) a prevalence of hospital-level concerns. Surgeons describe a complex set of factors that impact their antibiotic prescribing in pediatric surgical cases. They reported initial, but not ongoing, training and a use of individual weight of risk and benefit as a major dictator of prescribing practices. Antimicrobial stewardship programs should work with surgeons to develop acceptable implementation strategies to optimize antibiotic prescribing.
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