Antimicrobial Stewardship in Pediatric Surgery

Study Overview
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Brief Summary
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Acute appendicitis is a common surgical emergency in children. Non-perforated appendicitis patients do not require antibiotics after appendectomy. Although guidelines and recommendations exist to decrease post-operative antibiotic mis-use after appendectomy, surgeons continue to prescribe unwarranted antibiotics. The aim of this study is to determine if an Antimicrobial Stewardship Program in Pediatric Surgery will decrease the use of un-warranted antibiotics.

Detailed Description
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Many surgeons continue to treat non-perforated or borderline perforated appendicitis with postoperative antibiotics despite an evidence-based definition of perforation (in the pediatric surgical literature) and many guidelines and recommendations that specify that no postoperative antibiotics are required. Children with perforated appendicitis are also often treated with longer-than-necessary courses of antibiotics. Although surgeons may feel that they only prescribe additional doses on occasion, evidence suggests that this behavior occurs in over 50% of children with non-perforated appendicitis. These additional doses contribute to a longer length of stay, excess costs to the health care system, and disrupt patient flow. Additionally, the patients are exposed to more antibiotics and their potential for adverse effects (such as incorrect dose, incorrect medication, allergic reaction, antimicrobial resistance or c difficile infection). Antimicrobial stewardship programs have been successful in pediatrics and adult general surgery in curbing unwarranted antibiotic use, but have never been evaluated in pediatric general surgery.

Official Title
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An Antimicrobial Stewardship Intervention Program in Pediatric Surgery

Conditions
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Appendicitis

Intervention / Treatment
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* Other: Antimicrobial Stewardship Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participant (surgeon) is a pediatric surgeon at McMaster Children's Hospital and takes care of patients under the age of 18 who undergo appendectomy. Participant (surgeon) is able to read, write and understand English. Participant (surgeon) is able to provide informed consent. Exclusion Criteria: Participant (surgeon) only has patients who undergo drain insertion, PICC line insertion or a secondary operation during the same admission Participant (surgeon) only has patients who do not undergo operation (i.e. conservative management with interval appendectomy) Participant (surgeon) does not provide informed consent Participant (surgeon) does not understand written and spoken English diagnosis other than appendicitis at time of operation

Ages Eligible for Study
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Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| NO Antimicrobial Stewardship Program<br>Prospective cohort of children who undergo appendectomy for acute appendicitis (perforated and non-perforated) BEFORE the implementation of the Antimicrobial Stewardship Program. | |
| WITH Antimicrobial Stewardship Program<br>Prospective cohort of children who undergo appendectomy for acute appendicitis (perforated and non-perforated) WITH the implementation of the Antimicrobial Stewardship Program. | Other: Antimicrobial Stewardship Program<br>* Twice weekly meeting with Infectious Disease and Pediatric Surgery team members to audit antibiotics prescribed and suggest role for discontinuation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compliance with American Pediatric Surgical Association recommendations for postoperative antibiotics for appendicitis | Includes both intravenous and oral antibiotics prescribed, both during the time frame from admission until discharge, in addition to any prescription given for home, oral antibiotics. Measured as yes/no | From date of admission until first follow-up visit, typically within 4-6 weeks of discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative intravenous antibiotics for non-perforated appendicitis | measured as number of days (ie number of doses divided by number of doses-per-day) | From date of admission until first follow-up visit, typically within 4-6 weeks of discharge | 
| Postoperative oral antibiotics for non-perforated appendicitis | measured as number of days (ie number of doses divided by number of doses-per-day) | From date of admission until first follow-up visit, typically within 4-6 weeks of discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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antibiotic, antimicrobial, stewardship, child