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Chinese pediatric surgeons know prophylaxis guidelines but often fail to stop antibiotics at 24 hoursSurgeons show high knowledge but inconsistent habits with antibiotics

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Key Takeaway
Note that knowledge of prophylaxis guidelines does not guarantee compliance; only 74.8% of surgeons acknowledged the 24-hour stop rule.

This descriptive cross-sectional study surveyed 143 pediatric surgeons from children's hospitals in Jiangsu Province, China, to assess their knowledge, attitudes, and practices (KAP) regarding perioperative antimicrobial prophylaxis. The primary outcome was surgeons' KAP, with secondary outcomes exploring determinants of non-compliant behaviors.

Key findings: Surgeons showed high cognitive accuracy in drug selection (>84.0%) and administration timing (95.1%). However, only 74.8% acknowledged the 24-hour discontinuation standard for Class I (clean) incisions. A significant positive correlation was found between knowledge and practice scores (r = 0.579, P < 0.001).

Limitations noted by the authors include that high cognitive reserve does not ensure consistent implementation, and potential defensive medicine in high-risk departments may impair guideline adherence, though this requires further verification. The study is descriptive and cannot establish causality.

Practice relevance: The findings highlight a gap between knowledge and practice regarding timely discontinuation of prophylaxis, suggesting that educational interventions alone may be insufficient to improve adherence.

When a child goes into surgery, the right antibiotics are vital to prevent infection. A study of 143 pediatric surgeons in China looked at how these doctors understand and use those life-saving medicines. The results showed that most surgeons have very high knowledge scores when it comes to choosing the right drugs and timing their administration.

However, there is a gap between what they know and what they do. While 95.1% of surgeons knew the correct timing for starting antibiotics, only about 74.8% followed the standard rule to stop giving them after 24 hours for certain types of incisions. This shows that even when doctors are highly trained, specific habits can be hard to maintain consistently.

Researchers noted that having a lot of knowledge does not always guarantee perfect practice in every situation. Some factors, like the pressure of high-risk cases, might also influence how strictly these rules are followed. The study highlights a specific area where surgeons can improve their consistency to ensure the best care for children.

What this means for you:
Pediatric surgeons have high knowledge of antibiotics but show inconsistent habits regarding when to stop them.

Common questions

How much did the surgeons know about choosing the right antibiotics?

The survey showed that surgeons had a high level of cognitive accuracy when it came to drug selection. More than 84% of the surgeons surveyed demonstrated strong knowledge in choosing the correct medications for their patients.

What was the main gap found between surgeon knowledge and practice?

While 95.1% of surgeons knew the correct timing for starting antibiotics, only 74.8% acknowledged or followed the standard to stop them after 24 hours for Class I incisions. This shows a specific gap in following the discontinuation rules.

Does having high medical knowledge mean doctors will always follow every rule?

Not necessarily. The study found that even with high levels of knowledge, consistent implementation can be difficult. Factors like the pressure of high-risk departments might also impact how strictly a surgeon follows specific guidelines.

Study Details

Study typeGuideline
EvidenceLevel 5
PublishedJul 2026
View Original Abstract ↓
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. 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. 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  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.
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