Reduction of prophylactic antibiotics for elective pediatric cholecystectomy: A QI initiative to promote antimicrobial stewardship

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PURPOSE: Antibiotic prophylaxis minimizes the risk of infection, but overtreatment leads to antimicrobial resistance. Adult studies suggest antibiotic prophylaxis for elective cholecystectomy may not be needed. Our quality improvement project aimed to decrease prophylactic antibiotic use for elective cholecystectomies from 100 % to ≤50 % and maintain that rate for one year. METHODS: Prior to initiation, the pre-operative orderset was modified, education was provided, and surgeon consensus was achieved. All patients undergoing elective minimally invasive (laparoscopic and robotic) cholecystectomy were included. Exclusion criteria included acute cholecystitis, immunocompromised state, or performance of a combined procedure. Compliance was measured by chart review, with feedback provided for noncompliance. The project was initiated January 2024. Data were collected for twelve months prior (1/23-12/23) and after initiation (1/24-12/24). The balancing measure was surgical site infection (SSI). RESULTS: Ninety patients met inclusion criteria (40 pre-protocol and 50 post-protocol). Median age at surgery was 16 years (IQR 14, 17.2). Seventy-seven (86 %) patients were female. Prior to implementation, all patients (n = 40) received prophylactic antibiotics. In the first three months post-implementation, 3/16 (19 %) received antibiotic prophylaxis (due to inadequate communication with anesthesia providers). In the subsequent nine months, 0/34 (0 %) received antibiotic prophylaxis. One (2.5 %) patient in the pre-implementation group was noted to have an SSI requiring antibiotics vs. 3 (6 %) patients in the post-implementation group (p = 0.43). CONCLUSION: Use of prophylactic antibiotics for elective minimally invasive cholecystectomy decreased from 100 % to 6 % without significantly increasing the rate of SSI. Appropriately decreasing use of prophylactic antibiotics can improve antibiotic stewardship efforts. LEVEL OF EVIDENCE: Level III.

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