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Surgical Site Infection Prevention · Journal article
Journal of the Pediatric Infectious Diseases Society · September 1, 2026
Encouraging direction, but not yet definitive.
This quality improvement initiative implemented a bundled surgical antibiotic stewardship program at a tertiary children's hospital and demonstrated significant improvements in compliance with perioperative antibiotic recommendations across four key metrics (timing, redosing, spectrum, duration) compared to baseline. Clinical safety outcomes (readmission and surgical site infection rates) did not worsen, supporting feasibility of the approach in pediatric surgery.
Before-after quality improvement study. Pediatric patients undergoing clean and clean-contaminated surgical procedures at a single tertiary care children's hospital.. Intervention: Bundled surgical antimicrobial stewardship program including EMR-based real-time dashboard for monitoring, standardized prophylaxis protocols, scorecard dissemination to surgical leadership, EMR-based clinical decision support, and educati…. Compared with: Baseline period (Nov 2017–Oct 2019) prior to stewardship implementation.. Single center: Vanderbilt University Medical Center (Nashville, Tennessee, USA)..
Preoperative timing compliance improved from 97.3% to 98% (p<0.001) Redosing compliance improved from 50.9% to 93.3% (p<0.001) Antibiotic spectrum compliance improved from 79.1% to 89.8% (p<0.001)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
This work demonstrates that bundled antimicrobial stewardship interventions in pediatric surgery can successfully improve adherence to prophylaxis guidelines without increasing adverse outcomes. Clinicians and hospital leadership should consider similar structured approaches, particularly for redosing compliance, which showed the largest gap at baseline.
Quality improvement study showing significant compliance improvements across multiple antibiotic stewardship metrics without harm, but using process measures rather than hard clinical outcomes and lacking a concurrent control arm.
As stated by the source record.
Quoted from the source exactly as published.
This work demonstrates that bundled antimicrobial stewardship interventions in pediatric surgery can successfully improve adherence to prophylaxis guidelines without increasing adverse outcomes. Clinicians and hospital leadership should consider similar structured approaches, particularly for redosing compliance, which showed the largest gap at baseline.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Corresponding Author Sophie E. Katz, MD, MPH, Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, 2200 Children’s Way, Nashville, TN 37232, USA, (615) 343-6190. sophie.e.katz@vumc.org Funding No funding to report. Conflict(s) of Interest SK serves as a contractor for Merck and served as a consultant for Optum and received research support from Pfizer in the past year. All other authors have no conflict of interest or funding to disclose that is relevant to this research. Background Poor compliance with perioperative antibiotic prophylaxis recommendatikons is associated with increased risk of surgical site infection (SSI). Antimicrobial stewardship (AS) strategies are well established to improve antimicrobial use in the inpatient setting but not for surgical antibiotic prophylaxis. We describe implementation of surgical AS at a tertiary care children’s hospital and impact on perioperative antibiotic selection, timing and duration. Methods We conducted a quality improvement study of development and implementation of surgical AS. The baseline period was Nov 2017 – Oct 2019 and the implementation period was Nov 2019-Dec 2025. Prior to the baseline period, the surgical stewardship team (one AS clinician, an AS pharmacist, a surgical quality representative and a data analyst) began development of a Tableau dashboard to extract data from the electronic medical record in near real-time (EMR; Epic, Madison, WI) and track compliance by surgical service line with the following metrics for clean and clean-contaminated cases: preoperative timing, redosing, spectrum and post-operative duration of antibiotics (Table). Appropriate antibiotic was defined for each procedure type according to the National Surgical Quality Improvement Program (NSQIP) AS pilot. The dashboard captured specialty-specific and patient-level data to identify areas for improvement and increase buy-in from surgeons. Other strategies that were implemented sequentially included standardization of surgical prophylaxis recommendations (2021), dissemination of scorecards to surgical quality champions and division directors (2024), EMR interventions, and development and dissemination of educational materials (Figure). Results Compared to the baseline period, the implementation period had significant improvement in compliance with recommendations for preoperative timing (97.3 vs 98%, p<0.001), redosing (50.9 vs 93.3%, p<0.001), antibiotic spectrum (79.1 vs 89.8%, p<0.001) and postoperative duration (93.4 vs 96.8%, p<0.001); Figure). Compliance with each metric varied by surgical service line, with the greatest increase in redosing compliance for cardiac surgery (87.3 percent change, p<0.001; Table). There were no differences between the periods in readmission or SSI rates (Table). Conclusion Implementation of a bundled approach to surgical stewardship is feasible and safely improved judicious antibiotic use in several service lines.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.