Perioperative Prophylaxis in Pediatric Solid Organ Transplantation: A Baseline Stewardship Audit Using Routine Electronic Data

Background Perioperative antibacterial prophylaxis in pediatric solid organ transplantation varies by center in regimen, add‐on agents, and stop dates. We used institutional protocols as a unified reference standard to establish baseline stewardship measures and targets for future quality‐improvement work. Methods We retrospectively evaluated 164 pediatric transplants from 2010 to 2021. Using anesthesia timing and medication‐administration data, we assessed on‐time dosing, regimen selection, MRSA‐ and VRE‐directed add‐on agents, double anaerobic coverage, Gram‐negative broadening during the protocol window, and discontinuation at organ‐specific stop targets. We also used transplant‐day anchoring and protocol‐defined windows to describe whether primary‐admission broad‐spectrum exposure represented protocol‐linked prophylaxis or later exposure. The audit measured protocol concordance and exposure patterns, not the appropriateness of deviations. Results Prophylaxis was given on time in 95.7% of procedures. Overall, 87.2% received the recommended initial regimen, 7.3% the protocol‐defined beta‐lactam allergy regimen, and 4.3% another broad Gram‐negative regimen. Only 61.0% stopped the main regimen by the intended cutoff; stop performance was best in kidney transplantation and poorest in intestinal and multivisceral transplantation. MRSA‐directed add‐ons clustered in intestinal and multivisceral procedures and often extended beyond the intended duration. A secondary descriptive analysis identified contiguous protocol‐linked continuation beyond the intended window in 8.6% of primary‐admission broad‐spectrum days of therapy. Conclusions Timing and initial regimen selection were strong. The main baseline process measure requiring prospective review was continuation of protocol‐linked antibiotics beyond cutoffs in abdominal transplantation. This audit shows how routine electronic data can be used to create reproducible measures and organ‐specific targets for future stewardship and quality‐improvement studies.