Antimicrobial Stewardship in Pediatric Surgery
Antimicrobial Stewardship in Pediatric Surgery
Acute appendicitis is a common surgical emergency in children. Non-perforated appendicitis
 patients do not require antibiotics after appendectomy. Although guidelines and
 recommendations exist to decrease post-operative antibiotic mis-use after appendectomy,
 surgeons continue to prescribe unwarranted antibiotics.

 The aim of this study is to determine if an Antimicrobial Stewardship Program in Pediatric
 Surgery will decrease the use of un-warranted antibiotics.
Many surgeons continue to treat non-perforated or "borderline perforated" appendicitis with
 postoperative antibiotics despite an evidence-based definition of perforation (in the
 pediatric surgical literature) and many guidelines and recommendations that specify that no
 postoperative antibiotics are required. Children with perforated appendicitis are also often
 treated with longer-than-necessary courses of antibiotics. Although surgeons may feel that
 they only prescribe additional doses on occasion, evidence suggests that this behavior occurs
 in over 50% of children with non-perforated appendicitis.

 These additional doses contribute to a longer length of stay, excess costs to the health care
 system, and disrupt patient flow. Additionally, the patients are exposed to more antibiotics
 and their potential for adverse effects (such as incorrect dose, incorrect medication,
 allergic reaction, antimicrobial resistance or c difficile infection).

 Antimicrobial stewardship programs have been successful in pediatrics and adult general
 surgery in curbing unwarranted antibiotic use, but have never been evaluated in pediatric
 general surgery.
Inclusion Criteria:

 -  Participant (surgeon) is a pediatric surgeon at McMaster Children's Hospital and takes
 care of patients under the age of 18 who undergo appendectomy.

 -  Participant (surgeon) is able to read, write and understand English.

 -  Participant (surgeon) is able to provide informed consent.

 Exclusion Criteria:

 -  Participant (surgeon) only has patients who undergo drain insertion, PICC line
 insertion or a secondary operation during the same admission

 -  Participant (surgeon) only has patients who do not undergo operation (i.e.
 "conservative management with interval appendectomy)

 -  Participant (surgeon) does not provide informed consent

 -  Participant (surgeon) does not understand written and spoken English diagnosis other
 than appendicitis at time of operation