Impact of a clinical pathway-based antimicrobial stewardship program on surgical antibiotic prophylaxis in pediatric surgery: An uncontrolled pre-post quasi-experimental study.

BACKGROUND

Pediatric surgical antibiotic prophylaxis (SAP) is often inappropriate and contributes to avoidable antimicrobial exposure. We evaluated whether a clinical pathway-based antimicrobial stewardship program improved pediatric SAP appropriateness.

METHODS

In this single-center uncontrolled pre-post quasi-experimental study in a tertiary pediatric hospital in Tehran, Iran, clean or clean-contaminated procedures were screened before and after implementation. Overall appropriate SAP was assessed among all eligible surgeries (714 pre-intervention; 658 post-intervention). Compliance was analyzed in indicated-and-administered procedures (n = 447 per period). The intervention combined pathway-based education, dosing aids, stocking first-line agents, and pharmacist feedback. The primary outcome was composite compliance with 6 guideline-defined elements.

RESULTS

Overall appropriate SAP increased from 58.7% (419/714) to 74.2% (488/658; +15.5 percentage points; 95% CI 10.6-20.4; P < .001). Among indicated-and-administered cases, composite compliance increased from 74.9% to 85.0%, and complete compliance from 52.6% to 71.4% (both P < .001). Cefazolin-based regimens increased, while median doses of broader-spectrum agents declined.

DISCUSSION: Findings suggest improved SAP processes and reduced exposure, but inference is limited by the nonrandomized, single-center design and short follow-up.

CONCLUSIONS

The program was associated with better SAP performance and greater narrow-spectrum prophylaxis use. Multicenter studies with longer follow-up should assess sustainability and clinical outcomes.