Assessing the knowledge, attitudes and practices of physicians on perioperative antibiotic prophylaxis in pediatric surgery in China: a descriptive study

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Background Surgical site infection (SSI) prevention is a critical component of pediatric surgical safety, yet the irrational prolongation of perioperative antimicrobial prophylaxis (PAP) remains a global driver of antimicrobial resistance (AMR). While guidelines explicitly recommend discontinuing prophylaxis within 24 h for clean incisions, compliance varies significantly. This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of pediatric surgeons regarding PAP and to identify the determinants of non-compliant behaviors using a novel clustering approach. Methods A multicenter, cross-sectional study was conducted from July to August 2025 across Children's hospitals in Jiangsu Province, China. A total of 143 surgeons from different surgical departments (e.g., General Surgery, Orthopedics, Neurosurgery, Cardiothoracic Surgery) were surveyed using a validated questionnaire based on WHO guidelines. Data were analyzed using Spearman's rank correlation to assess knowledge-practice associations and K-Means clustering to identify distinct behavioral patterns among clinical departments. Results The study achieved a valid response rate of 95.3%. While surgeons demonstrated high cognitive accuracy regarding drug selection (>84.0%) and administration timing (95.1%), only 74.8% acknowledged the standard of discontinuing prophylaxis within 24 h for Class I incisions. A significant positive correlation was found between knowledge and practice scores ( r = 0.579, P < 0.001). However, cluster analysis revealed a “Knowledge-Practice Disassociation” pattern in the Oncology, Burns, and SICU departments. Conclusion A high level of cognitive reserve cannot ensure consistent implementation of standard practices. In high-risk departments, clinicians' focus on SSI rather than AMR may trigger defensive medicine, which is likely to impair guideline adherence. This association requires further verification in targeted investigations.

Knowledge-practice gaps in pediatric PAP discontinuation persist despite training; leaves open targeted stewardship interventions in high-risk departments.