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EPN 2021

Selim Oncel

Selim Oncel, Speaker at Pediatrics Conferences
Kocaeli University, Turkey
Title : Surgical antimicrobial prophylaxis practices in children A neglected field of irrational antibiotic use from a tertiary care hospital perspective


Introduction: Good surgical antimicrobial practices is of utmost importance to avoid exposing the patient unnecessarily to adverse effects of antibiotics, to prevent antimicrobial resistance, and to decrease hospitalization costs. Although well-established guidelines on surgical antimicrobial prophylaxis exist and there is not much debate on the principles of the prophylaxis, such as choosing a relatively narrow-spectrum antibiotic and cessation of its administration as soon as the surgery is over, we had the impression that adherence to guidelines is very low in making the decision to start prophylaxis, selecting the antibiotic, and setting the prophylaxis duration. Therefore we designed a study to reveal whether, or to which extent our impression is true.

Materials And Methods: In this cross-sectional, single-center study, the hospital records of 1,646 pediatric patients undergoing surgery between January 1, 2019 and December 31, 2019 were investigated in respect of adherence to current surgical antimicrobial prophylaxis guidelines.

Results: Sixty-four percent of the patients were male. The median of age was 7.7±5.8 years. Surgical wounds of the patients consisted of clean (68.6%), clean-contaminated (26.5%), and contaminated (4.9%) ones. Surgical procedures were mostly elective (70.5%). The most commonly used antibiotics were cefazolin (23.4%), ceftriaxone (14.2%), and amoxicillin-clavulanate (10.4%). Although prophylaxis was indicated in 70.6% of the cases, antibiotics for this purpose were administered to 59.9% of the patients. Selected antibiotics and their dosage was not appropriate in 80.4% and 90.0% of those patients receiving prophylactic antibiotics, respectively. In 68.2% of the patients, prophylactic antibiotic administration was extended well beyond surgical operation although guidelines suggest against this practice. Cefotaxime, ceftriaxone, and ampicilline-sulbactam were erroneous selections in 98.0%, 90.3%, and 71.4% of the cases, respectively. Amoxicillin-clavulanate, ampicillin, gentamicin, metronidazole, trimethoprim-sulfamethoxazole, and ciprofloxacin were chosen incorrectly in all cases. Cefazolin was ordered in 323 cases, 28.5% of them being incompatible with the guidelines. The dosage was wrong in all cases in which gentamicin, meropenem, trimethoprim-sulfamethoxazole, clindamycin, or ciprofloxacin was used for prophylaxis. Antibiotics, when ordered out of indication, tend to be given in a wrong dosage, compared to those ordered in line with guideline suggestions (P<0.001). Unnecessary costs regarding irrational antibiotic use alone amounted to approximately $7,000 per year.

Discussion: There are relatively few studies investigating surgical antimicrobial prophylaxis practices in children with the adherence to guidelines. To the best of our knowledge, our study is the first of its kind revealing the outlook of this neglected field of irrational antibiotic use in Turkey. Although carried out in a single center, we think that the study has a value as a reflection of the big picture in Turkish and global healthcare. Programs of decreasing antibiotic consumption focus on therapeutic antibiotic prescription ignoring the immense irrational antibiotic usage field of surgical antimicrobial prophylaxis in hospitals.

Conclusion: Surgeons making the decision to start antibiotics for prophylactic purposes to children should be kept up-to-date with seminars, courses, printed and electronic sources, and all the means possible with the guidance of routine surveillance by the hospital infection control committee.


Born in Ankara on March 20, 1967, Selim Öncel graduated from Ankara Ayşeabla Primary School and later from Ankara Atatürk Anatolian High School in 1985, the year he entered Ankara University Faculty of Medicine. In 1989, he studied as an exchange student in Odense Hospital (Denmark). He earned “Doctor of Medicine” and “Specialist” degrees in Pediatrics and Child Health, and Family Medicine in 1991, 1997, and 1999, respectively (specialist degrees from Ministry of Health Ankara Training and Research Hospital). During 1999-2003, he worked in the Health Department of the Directorate General of Security, in various private health institutions, and in his own solo practice office as a pediatrician; he also gave seminars in pediatrics and child health for a private education company. He has done his military service in 200-Bed Soldiers’ Hospital in Sarıkamış as a pediatrician. Following the completion of his Pediatric Infectious Diseases fellowship in Ankara University Faculty of Medicine in 2006, he began to work in Kocaeli University as an Assisstant Professor of Pediatrics and Child Health. Selim Öncel became an Associate Professor of Pediatric Infectious Diseases in 2013.