Rationalizing irrational prescribing-infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India.

Surendran, Surya, Nampoothiri, Vrinda, Dhar, Puneet, Holmes, Alison ORCID: 0000-0001-5554-5743, Singh, Sanjeev and Charani, Esmita ORCID: 0000-0002-5938-1202 (2024) Rationalizing irrational prescribing-infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India. JAC-antimicrobial resistance, 6 (4). dlae105-dlae105. ISSN 2632-1823, 2632-1823

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Abstract

<h4>Background and objectives</h4>Antibiotic use in paediatric surgical specialties is understudied. We investigated the antibiotic prescribing practices of paediatric general and cardiovascular surgical teams in a tertiary hospital in South India.<h4>Methods</h4>Mixed-methods study including observations from ward rounds, semi-structured interviews, and review of antibiotic prescribing. Field notes from observations and interview transcripts were coded using NVivo and thematically analysed. Data collection and analysis were iterative and continued until thematic saturation. Quantitative data were analysed using descriptive statistics.<h4>Results</h4>Data included 62 h of observation, 24 interviews, one case study and 200 patient chart reviews (100/specialty). Senior surgeons make key decisions, referring to their own experience when prescribing antibiotics. Being outcome-driven, the doctors often prescribe antibiotics at the earliest indication of infection with a reluctance to de-escalate, even when an infection is not diagnosed. This practice is more acute among surgeons who consider themselves responsible for their patients' health and attribute the consistently low surgical site infection rates to this practice.In general surgery, 83.3% (80/96; 4 lost to follow-up) of patients were prescribed antibiotics for the duration of their stay with oral antibiotics prescribed at discharge. The surgeons use antibiotics prophylactically for patients who may be vulnerable to infection. The antimicrobial stewardship team was considered to have limited influence in the decision-making process.<h4>Conclusions</h4>Outcome-driven decision-making in surgery leads to overprescription of antibiotics and prolonged surgical prophylaxis. The rationale for suboptimal practices is complicated by the surgeons' beliefs about the contextual determinants of health in India.

Item Type:	Article
Uncontrolled Keywords:	3214 Pharmacology and Pharmaceutical Sciences, 3207 Medical Microbiology, 32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, 7.3 Management and decision making, 8.1 Organisation and delivery of services, Infection, 3 Good Health and Well Being
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Systems, Molec & Integrative Biology > Inst. Systems, Molec & Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	20 Sep 2024 13:34
Last Modified:	17 Jan 2026 00:06
DOI:	10.1093/jacamr/dlae105
Open Access URL:	https://doi.org/10.1093/jacamr/dlae105
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3184658
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