Category: Pediatric Antimicrobial Stewardship (inpatient/outpatient pediatric focused)

Poster Session: Pediatric Antimicrobial Stewardship (inpatient/outpatient pediatric focused)

1361 - Variation in Perioperative Antibiotic Use for Children Undergoing Congenital Heart Disease Surgery in U.S. Academically Affiliated Centers

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Presenting Author(s)

Peter B. Cooch

Pediatric Infectious Diseases Fellow
University of California, San Francisco
San Francisco, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Rachel L. Wattier

Associate Professor of Clinical Pediatrics
University of California, San Francisco
San Francisco, CA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MS

Martina Steurer-Muller

Associate Professor of Pediatrics
University of California, San Francisco
San Francisco, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Perioperative antibiotics (PA) are routinely given to children undergoing congenital heart disease (CHD) surgery to prevent surgical site infection. National guidelines recommend narrow-spectrum PA (such as Cefazolin) for most CHD procedures. However, indications for broad-spectrum PA are not well established, and limited literature suggests high exposure to broad-spectrum PA in this population. We performed a contemporary, multicenter description of prevalence and variability of broad-spectrum PA exposure within the pediatric CHD surgical population.

Methods: We identified children 0-17 years admitted to U.S. academically-affiliated centers participating in the Vizient Clinical Database/Resource Manager from 2011-2018. Patients who had ICD-9 and ICD-10 codes indicating a CHD surgical procedure with intravenous antibiotics initiated the day of surgery were eligible for inclusion. Antibiotics broader than first- and second-generation cephalosporins were designated broad-spectrum. We excluded centers with 5 or fewer annual procedures. We excluded patients undergoing heart transplant, concurrent non-cardiac procedures, and those with missing medication data.

Results: 19,152 hospital admissions from 24 centers met inclusion criteria. 55% of patients were male, 18% were under 30 days of age at time of surgery, and 5.1% had diagnosis codes for prematurity. Broad spectrum antibiotics were administered in 21.4% of CHD procedures during the study period. Between the 24 centers, the proportion of surgical cases given broad-spectrum PA ranged from 1.5% to 95%, which was unrelated to center annual surgical volume. Children under 30 days of age and those with prematurity were significantly more likely to receive broad-spectrum agents. Vancomycin was the primary antibiotic contributing to broad-spectrum PA exposure.

Conclusion: Substantial variation in broad-spectrum PA use was observed among children undergoing congenital heart disease surgery in academically affiliated United States centers from 2011-2018. Neonates and premature infants have the highest rates of exposure to broad-spectrum antibiotics. Standardization of perioperative antibiotics in CHD surgery is a potential intervention to limit antibiotic exposure in young infants.