Rational antibiotic prophylaxis in a multidisciplinary pediatric hospital

Introduction. Healthcare-associated infections, and particularly surgical site infections, represent one of the key challenges in modern medicine. Surgical site infections worsen clinical outcomes, contribute to the rise of antibiotic resistance, increase treatment duration, and require repeat surgical interventions. Perioperative antibiotic prophylaxis can reduce the incidence of surgical site infections by up to 50%; however, in real-world clinical practice, its effectiveness is limited due to non-adherence to the principles of appropriate drug selection, timely administration, and duration of therapy. Insufficient adherence to clinical guidelines necessitates the implementation of clear algorithms for the use of antibacterial drugs in the perioperative period and increasing physician awareness of rational perioperative antibiotic prophylaxis. Aim — to develop algorithms for rational perioperative antibiotic prophylaxis in a multidisciplinary children’s hospital and a perinatal center, aimed at reducing the incidence of surgical site infections and improving the quality of medical care. Materials and methods. Based on an analysis of current clinical guidelines, healthcare standards, and principles of evidence-based medicine, the author team developed perioperative antibiotic prophylaxis algorithms for pediatric surgical patients. Results. A set of perioperative antibiotic prophylaxis algorithms was developed, including 10 key provisions regulating indications for prophylaxis depending on wound class, drug administration 30–60 minutes before skin incision, the necessity of intraoperative re-dosing in case of blood loss exceeding 1500 ml or if the operation duration exceeds two antibiotic half-lives. Risk factors for surgical site infections, related to both the patient and the surgical procedure, are systematized. The etiology of surgical site infections was clarified, showing a predominance of Enterococcus spp. (17.6%), E. coli (17.2%), S. aureus (15.2%), and coagulase-negative staphylococci, including methicillin-resistant staphylococcal strains MRSA and MRSE. Conclusion. The developed perioperative antibiotic prophylaxis algorithms, based on clinical guidelines and local antibiotic resistance data, allow for the standardization of prophylaxis in children, taking into account individual risk factors. Their implementation ensures a reduction in surgical site infections incidence, improved surgical outcomes, and a shortened length of hospitalization.