S. K. Walker1, R. L. Massoumi4, E. R. Gross3, M. Knezevich1, M. R. Uhing2, M. J. Arca1 1Medical College Of Wisconsin,Pediatric Surgery/Surgery,Milwaukee, WI, USA 2Medical College Of Wisconsin,Neonatology/Pediatrics,Milwaukee, WI, USA 3University Of Colorado Denver,Surgery/Pediatric Surgery,Aurora, CO, USA 4University Of California – Los Angeles,General Surgery/Surgery,Los Angeles, CA, USA
Introduction: Newborns with congenital anomalies often receive empiric postnatal antibiotics as prophylaxis for possible complications arising from their anomalies. No data exist to support this practice. We implemented an antibiotic stewardship program in our Neonatal Intensive Care Unit, whereby postnatal antibiotics were given to newborns with congenital anomalies only if specific indications (e.g., chorioamnionitis, fevers) exist and peri-operative antibiotics were standardized to piperacillin/tazobactam given no more than 72 hours postoperatively. We hypothesized that judicious antibiotic use would have no effect on postoperative infectious complications.
Methods: We conducted an IRB-approved retrospective chart review of all neonates born with esophageal atresia +/- tracheoesophageal fistula, duodenal atresia, intestinal atresia, anorectal malformations, congenital diaphragmatic hernia, omphalocele, and cloacal anomaly in the time periods before (1/1/2009-6/30/2012) and after (7/1/12-3/30/14) antibiotic protocol implementation. Outcome measures were the development of surgical site infections (SSI) and hospital acquired infections (HAI) including those with multidrug resistant organisms (MDRO). Statistical analyses were performed using Student’s t-test for continuous variables and Chi-square for categorical variables.
Results: The study population consists of 160 pre-protocol and 136 post-protocol newborns. There were no statistical differences in birth weight, gender, inborn status, delivery methods, maternal group B Streptococcal status, cardiac and non-cardiac comorbidities, or individual diagnoses. The average pre-protocol gestational age was younger than the post-protocol group (36.56 +/- 2.58 vs 37.12 +/- 2.35 weeks, p=0.04). Day of surgery variables such as weight, day of life, and ASA status were not statistically significant between groups. Pre-protocol, 57.5% received perinatal antibiotics compared to 39% post-protocol (p=0.001) The pre-protocol group received antibiotics longer (2.99 +/- 1.26 days) than the post-protocol group (2.40 +/- 1.06 days, p=0.004). We observed more SSI’s in the pre-protocol period (16% vs. 9%, p=0.046). Operative intervention for SSI was required in 29.6% of the pre-protocol patients, while none was required in the post-protocol group. There was no difference in HAI between the groups (13.8% vs. 11.8%, p=0.42), but there was a difference in number of patients with MDRO (7.5% vs. 2%, p=0.04). When we compared the subgroups that both received antenatal antibiotics, higher SSI was noted in the pre-protocol group (17% vs. 5.7%, p =0.04).
Conclusion: The implementation of an antibiotic protocol in newborns with congenital anomalies requiring operative intervention resulted in decreased frequency and duration of antibiotic use postnatally. This change in practice may be associated with decreased incidence of SSI and isolation of MDRO without an increased risk of other HAI.