A cyclometalated N-heterocyclic carbene and acetylacetonate ligands in a phosphorescent Pt(II) dye for sensing glucose

New β-diketonate platinum (II) complexes, containing a cyclometalated N-heterocyclic carbene [Pt(Naph^C*iPr)(acac)] (3A) (HNaph^C*-κC* = 3-isopropyl-1-(naphthalen-2-yl)-1H-imidazole-2-ylidene), or a cyclometalated pyrazole, [Pt(Naph^Npz)(acac)] (3B) (HC^Npz = 1-(naphthalen-2-yl)-1H-pyrazole) and [Pt(Naph^Ndmpz)(acac)] (3B') (HC^Ndmpz = 1-(naphthalen-2-yl)-1H-3,5-dimethylpyrazole) have been prepared and characterized. Their absorption and emission properties in films of ethyl cellulose (EC) were determined along with those of the already reported for complex [Pt(Naph^C*Me)(acac)] (3A'). They showed that all four β-diketonate complexes display a bright phosphorescent emission with maxima in the blue region (λmax ∼ 480 nm for 3A and 3A'; 490 nm 3B and 3B'). The higher quantum yield (QY), longer decay times and greater oxygen sensitivity were exhibited by the Naph^C* derivatives, compared to the Naph^N ones. Polyacrylamide membranes with entrapped 3A' as dye, and glucose oxidase (GOx) enzyme were used for monitoring glucose level. The RSD is about 5% and the detection limit is at ∼5·10−4 M, with a response time usually of 10–15 min working in stop-flow mode. These platinum-based membranes respond reversibly to glucose for, at least, 20 measures. 3A’ is the first Pt(II) complex bearing a cyclometalated N-heterocyclic carbene ever used as dye for sensing glucose

Antifungal stewardship in a tertiary care paediatric hospital : the PROAFUNGI study

The increasing use of antifungal drugs (AF) in children and the concern for related adverse events and costs has led to the development of specific AF stewardship programmes (AFS). Studies in adult patients have shown improvements in AF prescription and usage after implementation, but paediatric data are scant. The aim of this PROAFUNGI study was to describe the use and appropriateness of AF in a high complexity paediatric centre. Observational, prospective, single-centre, modified point-prevalence study (11 surveys, July-October 2018), including paediatric (< 18 years) patients receiving at least one systemic AF. Prescriptions were evaluated by the AFS team. The study included 119 prescriptions in 55 patients (53% males, median age 8.7 years [IQR 2.4-13.8]). The main underlying condition was cancer (45.5% of patients; HSCT in 60% of them); and the first indication for AF was prophylaxis (75 prescriptions, 63.2%). Liposomal amphotericin B was used most commonly (46% prescriptions), mainly as prophylaxis (75%). Among the 219 evaluations, 195 (89%) were considered optimal. The reason for non-optimal prescriptions was mostly lack of indication (14/24), especially in critical patients with ventricular assist devices. The use of AF without paediatric approval accounted for 8/24 inappropriate prescriptions. A high rate of AF appropriateness was found for the children's hospital as a whole, in relation with a well-established AFS. Nonetheless, the identification of specific areas of improvement should guide future actions of the AFS team, which will focus mainly on prophylaxis in critically ill patients receiving circulatory assistance and the use of non-approved drugs in children

Influenza-Associated Disseminated Aspergillosis in a 9-Year-Old Girl Requiring ECMO Support

Nens; Influenza humana; IsavuconazolNiños; Influenza humana; IsavuconazolChildren; Human influenza; IsavuconazoleA previously healthy 9-year-old girl developed fulminant myocarditis due to severe influenza A infection complicated with methicillin-resistant Staphylococcus aureus pneumonia, requiring extracorporeal membrane oxygenation (ECMO) support. Twelve days after admission, Aspergillus fumigatus was isolated in tracheal aspirate, and 12 h later she suddenly developed anisocoria. Computed tomography (CT) of the head showed fungal brain lesions. Urgent decompressive craniectomy with lesion drainage was performed; histopathology found hyphae in surgical samples, culture-positive for Aspergillus fumigatus (susceptible to azoles, echinocandins, and amphotericin B). Extension workup showed disseminated aspergillosis. After multiple surgeries and combined antifungal therapy (isavuconazole plus liposomal amphotericin B), her clinical course was favorable. Isavuconazole therapeutic drug monitoring was performed weekly. Extensive immunological study ruled out primary immunodeficiencies. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) follow-up showed a gradual decrease in fungal lesions. Influenza-associated pulmonary aspergillosis is well-recognized in critically ill adult patients, but pediatric data are scant. Clinical features described in adults concur with those of our case. Isavuconazole, an off-label drug in children, was chosen because our patient had severe renal failure. To conclude, influenza-associated pulmonary aspergillosis is uncommon in children admitted to intensive care for severe influenza, but pediatricians should be highly aware of this condition to enable prompt diagnosis and treatment.This work received no external funding

Posicionamiento de la sociedad Española de infectología pediátrica sobre la implementación, ejecución y monitorización de los programas de optimización de uso de antimicrobianos (PROA) en pediatría hospitalaria

Pediatría; Resistencia antibióticaPaediatrics; Antimicrobial resistancePediatria; Resistència antibiòticaIn the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately. The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential. The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country.Durante los últimos años ha habido un aumento en la aparición de resistencias antimicrobianas, lo cual supone un grave problema de salud pública. El mal uso de antimicrobianos es un factor determinante en su desarrollo. La población pediátrica no queda exenta de dicha problemática ya que la prescripción de antibióticos en pediatría es elevada y en muchas ocasiones inadecuada. La incorporación de los programas de optimización de uso de antimicrobianos (PROA) ha resultado ser una medida crucial para disminuir el riesgo en la aparición de resistencias antibióticas. A nivel internacional se reconoce la necesidad de crear PROAs específicos en pediatría (PROA-P) debido a las diferencias existentes entre pacientes adultos y pediátricos en referencia a las infecciones, así como al abordaje tanto diagnóstico como terapéutico de las mismas. Por esta misma razón, los PROA-P deben ser programas multidisciplinares liderados por especialistas en infecciones pediátricas y trabajar con indicadores específicos pediátricos (DOT, patrones de sensibilidad antibiótica de población pediátrica, indicadores clínicos…) que permitan detectar puntos de mejora y establecer estrategias dirigidas eficaces. Por otro lado, es imprescindible el apoyo y liderazgo por parte de las distintas sociedades científicas implicadas. El objetivo de este documento es dar a conocer el posicionamiento de la Sociedad Española de Infectología Pediátrica (SEIP) sobre la implementación de los PROA pediátricos hospitalarios en nuestro territorio así como aportar herramientas que ayuden en la aplicación de dichos programas en los diferentes hospitales de las distintas regiones sanitarias del país

The challenge of the laboratory diagnosis in a confirmed congenital Zika virus syndrome in utero: A case report

Zika virus; Diagnosis; Infection in uteroVirus Zika; Diagnòstic; Infecció uterinaVirus Zika; Diagnóstico; Infección uterinaINTRODUCTION: Zika virus (ZIKV) has caused one of the most challenging global infectious epidemics in recent years because of its causal association with severe microcephaly and other congenital malformations. The diagnosis of viral infections usually relies on the detection of virus proteins or genetic material in clinical samples as well as on the infected host immune responses. Serial serologic testing is required for the diagnosis of congenital infection when diagnostic molecular biology is not possible. PATIENT CONCERNS: A 2-year-old girl, born to a mother with confirmed ZIKV infection during pregnancy, with a confirmed ZIKV infection in utero, showed at birth a severe microcephaly and clinical characteristics of fetal brain disruption sequence compatible with a congenital ZIKV syndrome (CZS). DIAGNOSIS: ZIKV-RNA and ZIKV-IgM serological response performed at birth and during the follow-up time tested always negative. Serial serologic ZIKV-IgG tests were performed to assess the laboratory ZIKV diagnosis, ZIKV-IgG seroreversion was observed at 21 months of age. ZIKV diagnosis of this baby had to be relied on her clinical and radiological characteristics that were compatible with a CZS. INTERVENTIONS: The patient was followed-up as per protocol at approximately 1, 4, 9, 12, 18-21, and 24 months of age. Neurological, radiological, audiological, and ophthalmological assessment were performed during this period of time. Prompt rehabilitation was initiated to prevent potential adverse long-term neurological outcomes. OUTCOMES: The growth of this girl showed a great restriction at 24 months of age with a weight of 8.5 kg (-2.5 z-score) and a head circumference of 40.5 cm (-4.8 z-score). She also had a great neurodevelopmental delay at the time of this report. CONCLUSION: We presume that as a consequence of prenatal ZIKV infection, the fetal brain and other organs are damaged before birth through direct injury. Following this, active infection ends during intrauterine life, and as a consequence the immune system of the infant is unable to build up a consistent immune response thereafter. Further understanding of the mechanisms taking part in the pathogenesis of ZIKV congenital infection is needed. This finding might change our paradigm regarding serological response in the ZIKV congenital infection

Programa de vigilància de les infeccions relacionades amb l’atenció sanitària de Catalunya (VINCat): manual VINCat

Atenció sanitària; Infeccions; Enquesta; MetodologiaAtención sanitaria; Infecciones; Encuesta; MetodologíaHealth care; Infections; Poll; MethodologyEl compliment d’aquest objectiu es fa mitjançant una enquesta puntual de prevalença. L’objectiu del protocol de prevalença de les infeccions relacionades amb l'atenció sanitària (IRAS) és que aquest es pugui implementar a tots els centres, sense necessitat d’afegir-hi recursos especials. La Comissió d’Infeccions de cada centre ha de designar el personal encarregat de l’estudi i ha de treballar amb l’ajuda del personal de medicina i d’infermeria assistencial responsable del malalt, i amb la col·laboració de serveis centrals com el de microbiologia. És important que els professionals que recullen les dades tinguin experiència en vigilància de les IRAS i coneguin les definicions i la metodologia de treball. Recomanem que hi hagi un coordinador que assumeixi les tasques d’informació, formació i validació de les dades, que ha de ser un membre del Grup de Control de la Infecció

Programa de vigilància de les infeccions relacionades amb l’atenció sanitària de Catalunya (VINCat): manual VINCat

Atenció sanitària; Infeccions; Enquesta; MetodologiaAtención sanitaria; Infecciones; Encuesta; MetodologíaHealth care; Infections; Poll; MethodologyEl VINCat és un programa del Servei Català de la Salut que estableix un sistema de vigilància unificat de les infeccions relacionat amb l’atenció sanitària (IRAS) als centres de salut de Catalunya. La seva missió és contribuir a reduir les taxes d’aquestes infeccions mitjançant la vigilància epidemiològica activa i continuada. El programa es fonamenta en la tasca que porten a terme els professionals dels equips multidisciplinaris de control d’infecció dels centres de salut catalan

Informe VINCat

Infeccions nosocomials; Hospitals; Vigilància epidemiològicaInfecciones nosocomiales; Hospitales; Vigilancia epidemiológicaNosocomial infections; Hospitals; Epidemiological surveillanceVINCat és un programa del Servei Català de la Salut que estableix un sistema de vigilància unificat de les infeccions nosocomials als hospitals de Catalunya. La seva missió és contribuir a reduir les taxes d’aquestes infeccions mitjançant la vigilància epidemiològica activa i continuada. El programa es fonamenta en la tasca que porten a terme els professionals dels equips multidisciplinaris de control d’infecció dels hospitals catalans.VINCat is a program of the Catalan Health Service that establishes a unified surveillance system for nosocomial infections in hospitals in Catalonia. Its mission is to help reduce the rates of these infections through active and ongoing epidemiological surveillance. The program is based on the work carried out by the multidisciplinary teams of infection control of Catalan hospitals.VINCat es un programa del Servicio Catalán de la Salud que establece un sistema de vigilancia unificado de las infecciones nosocomiales en los hospitales de Cataluña. Su misión es contribuir a reducir las tasas de estas infecciones mediante la vigilancia epidemiológica activa y continuada. El programa se fundamenta en la tarea que llevan a cabo los profesionales de los equipos multidisciplinares de control de infección de los hospitales catalanes

COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72–14·87; p=0·0035), male sex (2·12, 1·06–4·21; p=0·033), pre-existing medical conditions (3·27, 1·67–6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16–21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir–ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20–1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. Funding ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit

Profilaxis quirúrgica en un programa de uso adecuado de antimicrobianos en pediatría (PROA-NEN)

Introducció. La infecció de ferida quirúrgica (IFQ) és una infecció relacionada amb l'assistència sanitària freqüent, amb important impacte clínic. El bon ús de la profilaxi antibiòtica quirúrgica (PAQ) ha demostrat ser una mesura eficaç en la disminució de la incidència de la IFQ. Tot i això, la adherència a les guies de PAQ és subòptima, amb un ús excessiu d'antibiòtics. Tots els programes PROA (adults; pediàtrics) han de comptar amb una línia de treball estratègica per a millorar la PAQ. Des de l'instuticionalització del PROA pediàtric del nostre centre (PROA-NEN) en 2015, l'optimització de la PAQ fou un objectiu clau. Objectiu: avaluar l'impacte de la intervenció d'un programa PROA específic pediàtric (PROA-NEN) en la qualitat de la PAQ i de la incidència d'IFQ d'un hospital pediàtric de tercer nivell. Pacients i mètodes. Estudi prospectiu, quasiexperimental, unicèntric, a un hospital pediàtric de tercer nivell. Es van incloure pacients pediàtrics no nounats, sotmesos a cirurgies no ambulatòries durant 5 períodes d'estudi de 21 dies cadascú (2016-2018). S'analitzaren variables basals dels pacients i de les cirurgies realitzades. L'anàlisi de la qualitat de la PAQ es va realitzar amb indicadors de procés i de resultat. Els indicadors de procés van ser els publicats per l'ECDC al 2013: disponibilitat d'un equip multidisciplinar destinat a la implantació de la PAQ, disponibilitat d'un responsable del compliment de la PAQ dins de quiròfan, l'adequació temporal de la PAQ, adequació de la indicació, tipus d'antibiòtic i redosificació intraoperatòria de la PAQ i la durada de la PAQ. Referent als indicadors de resultat, es va calcular el consum d'antibiòtics a la PAQ a través de DOT (dies de tractament) i com indicador clínic es va avaluar la incidència d'IFQ. Resultats. S'analitzaren 425 cirurgies (62 preintervenció i 363 posintervenció), de totes les especialitats quirúrgiques pediàtriques. Un total de 403 pacients, 56,6% de sexe masculí, amb una mediana d'edat de 6,3 anys, (p25: 2,1, p75: 11,9). Segons el grau de contaminació, un 72% foren cirurgies netes, un 20%, netes-contaminades i un 8%, brutes. En un 52% la PAQ estava indicada. Referent a l'anàlisis posterior, va haver una millora generalitzada de tots els indicadors de procés. L'adequació en el moment de l'administració de la dosi preoperatòria va augmentar des d'un 34,4% fins al 49,2% (p=0,12). Es va observar un ascens en l'adequació de la indicació de la PAQ, des d'un 77% fins a un 91,5% (p=0,002). Amb una millora significativa en la no administració de la PAQ quan no estava indicada (des d'un 54,5% fins a un 87% d'adequació, p=0,001). En referència a l'ús adequat de l'antibiòtic, va haver un augment del compliment, del 67,5% fins al 91,4% a la posintervenció (p=0,001). La durada de la PAQ, inferior a les 24 hores, va ser adequada en un 67,6% durant el període preintervenció i en un 79,5% posteriorment (p=0,129). El compliment complet de la PAQ va augmentar significativament des d'un 31,5% fins a un 57% (p<0,005). Pel que fa al consum dels antibiòtics a les àrees quirúrgiques, es va veure una tendència al descens, amb DOT/100 estades de 69 durant el periode preintervenció i de 60, l'any 2018. Els resultats clínics van mostrar un índex d'infecció del 3 % en el primer període i del 0,8% després de la intervenció PROA-NEN. Conclusió. Una intervenció PROA, dirigida a la PAQ ha demostrat millorar la qualitat del seu ús, amb un descens del consum innecessari i inadequat dels antibiòtics administrats amb aquesta indicació amb un descens de incidència de la IFQ.Introducción. La infección de la herida quirúrgica (IHQ) es una infección relacionada con la asistencia sanitaria frecuente, con importante impacto clínico. El buen uso de la profilaxis antibiótica quirúrgica (PAQ) ha demostrado ser una medida eficaz en la disminución de la incidencia de IHQ. No obstante, la adherencia a las guías de PAQ es subóptima, con un uso excesivo de los antibióticos. Todos los programas PROA (adultos y pediátricos) deben poseer una línea de trabajo estratégica para mejorar la PAQ. Desde la institucionalización del PROA pediátrico de nuestro centro (PROA-NEN) en 2015, la optimización de la PAQ fue un objetivo primordial. Objetivo: evaluar el impacto de una intervención de un programa PROA específico pediátrico (PROA-NEN) en la calidad de la PAQ y en la incidencia de IHQ en un hospital pediátrico de tercer nivel. Pacientes y métodos. Estudio prospectivo, cuasiexperimental, unicéntrico, de un hospital pediátrico de tercer nivel. Se incluyeron pacientes pediátricos no neonatales, sometidos a cirugías no ambulatorias durante 5 periodos de estudio de 21 días cada uno (2016-2018). Se analizaron variables basales de los pacientes y de las cirugías realizadas. El análisis de la calidad de la PAQ se realizó con indicadores de proceso y de resultado. Los indicadores de proceso fueron los publicados en 2013 por el ECDC: disponibilidad de un equipo multidisciplinar destinado a la implantación de la PAQ, disponibilidad de un responsable del cumplimiento de la PAQ intraquirófano, adecuación temporal de la PAQ, adecuación de la indicación, tipo de antibiótico y redosificación intraoperatoria de la PAQ y duración de la PAQ. Referente a indicadores de resultado, se midió el consumo del antibiótico en PAQ a través de DOT (días de tratamiento) y como indicador clínico se evaluó la incidencia de IHQ. Resultados. Se analizaron 425 cirugías (62 preintervención y 363 posintervención), de todas las especialidades quirúrgicas pediátricas. Un total de 403 pacientes, 56,6% de sexo masculino y con una mediana de edad de 6,3 años, (p25: 2,1, p75: 11,9 años). Según el grado de contaminación, un 72% fueron cirugías limpias, un 20%, limpias-contaminadas y un 8%, sucias. En un 52% la PAQ estaba indicada. Referente al análisis posterior, hubo una mejora generalizada de todos los indicadores de proceso. La adecuación en el tiempo de administración de la PAQ previo a la cirugía aumentó desde un 34,4% hasta el 49,2% (p=0,12). Se observó una mejora en la adecuación de la indicación de la PAQ, desde un 77% hasta un 91,5% (p=0,002). Con una mejoría significativa en la no administración de la PAQ cuando no estaba indicada (desde un 54,5% a un 87% de adecuación, p=0,001). En referencia al uso adecuado del antibiótico, hubo un aumento del cumplimiento, del 67,5% al 91,4% posintervención (p=0,001). La duración de la PAQ, inferior a las 24 horas, fue adecuada en el 67,6% en el periodo preintervención y en un 79,5% posteriormente (p=0,129). El cumplimiento completo de la PAQ aumentó de manera significativa desde un 31,5% hasta un 57% (p<0,005). En cuanto al consumo de antibióticos en las áreas quirúrgicas, se observó una tendencia al descenso, con DOT/100 estancias de 69 en el periodo preintervención, y de 60, en el año 2018. Los resultados clínicos mostraron un índice de infección del 3 % en el primer periodo y del 0,8% tras la intervención PROA-NEN. Conclusión. Una intervención PROA, dirigida a la PAQ ha demostrado mejorar la calidad de su uso, con un descenso del consumo innecesario e inadecuado de los antibióticos administrados con dicha indicación, y disminuir la incidencia de IHQ.Introduction. Surgical site infection (SSI) is a common healthcare-related infection with significant clinical impact. The correct use of surgical antibiotic prophylaxis (SAP) has proven to be an effective measure in reducing the incidence of SSI. However, adherence to SAP guidelines is suboptimal, with excessive use of antibiotics. All antibiotic stewardship programs (ASP) must have a strategic line of work to improve SAP. Since the institutionalization of the paediatric ASP of our centre (PROA-NEN) in 2015, the optimization of the SAP has been a primary objective. Objective: to evaluate the impact of an intervention of a specific paediatric ASP (PROA-NEN) on the quality of the SAP and on the incidence of SSI in a tertiary paediatric hospital. Patients and methods. A prospective, quasi-experimental, single-centre study of a third-level paediatric hospital. Non-neonatal paediatric patients, who underwent non-ambulatory surgeries during 5 study periods of 21 days each (2016-2018), were included. Baseline variables of the patients and the surgeries performed were analysed. The analysis of the quality of the SAP was carried out with process and result indicators. The process indicators were those published in 2013 by the ECDC: availability of a multidisciplinary team for the implementation of the SAP, availability of a person responsible for compliance with the intraoperative SAP, temporal adequacy of the SAP, adequacy of the indication, type of antibiotic and intraoperative redosing of SAP and duration of SAP. Regarding outcome indicators, the consumption of the antibiotic in SAP was measured through DOT (days of treatment) and the incidence of SSI was evaluated as a clinical indicator. Results. 425 surgeries were analysed (62 pre-intervention and 363 post-intervention), from all paediatric surgical specialties. A total of 403 patients, 56.6% male and with a median age of 6.3 years ( p25: 2,1, p75: 11,9 years) According to the degree of contamination, 72% were clean surgeries, 20% were clean-contaminated and 8% were dirty. In 52% the SAP was indicated. Regarding the subsequent analysis, there was a general improvement of all the process indicators. The adequacy in the time of administration of the SAP prior to surgery increased from 34.4% to 49.2% (p = 0.12). An improvement in the adequacy of the SAP indication is projected, from 77% to 91.5% (p = 0.002). With a significant improvement in not administering SAP when it was not indicated (from 54.5% to 87% of adequacy, p = 0.001). Regarding the appropriate use of the antibiotic, there was an increase in compliance, from 67.5% to 91.4% post-intervention (p = 0.001). The duration of the PAQ, less than 24 hours, was adequate in 67.6% in the pre-intervention period and in 79.5% afterwards (p = 0.129). Complete compliance with the SAP increased significantly from 31.5% to 57% (p <0.005). Regarding the consumption of antibiotics in surgical areas, a downward trend is shown, with DOT / 100 stays of 69 in the pre-intervention period, and 60, in 2018, in the first period and 0.8% after the PROA-NEN intervention. Conclusion: An ASP intervention, aimed at SAP has been shown to improve the quality of its use, with a decrease in the unnecessary and inappropriate use of antibiotics administered with this indication, with decreasing the incidence of SSI