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The bacteriology of children before primary cleft lip and palate surgery
1Plastic Surgery, Bradford Royal Infirmary, West Yorkshire, United Kingdom.
Insights
Children undergoing cleft lip and palate surgery often carry Staphylococcus aureus, posing a surgical risk. Preoperative screening for bacteria like Staphylococcus aureus and beta-hemolytic streptococcus is crucial for managing infection risk.
Area of Science:
- Pediatric Surgery
- Microbiology
- Craniofacial Anomalies
Background:
- Bacterial infections are a significant complication in pediatric surgical procedures.
- Understanding the prevalence of pathogenic bacteria in children with cleft lip and palate is essential for effective risk management.
- This includes determining the necessity of prophylactic antibiotic administration.
Purpose of the Study:
- To review the preoperative bacteriology of children scheduled for primary cleft lip and palate surgery.
- To identify common bacterial flora in this patient population.
Main Methods:
- A retrospective analysis was conducted on microbiological swabs (nose, throat, ear) from children aged 1-26 months.
- Swabs were collected prior to primary cleft lip, palate, or combined lip/palate repair.
- Positive results were defined by the presence of Staphylococcus aureus or beta-hemolytic streptococcus.
Main Results:
- Out of 326 preoperative swabs analyzed from 250 patients, 91 (27.9%) were positive for target bacteria.
- Staphylococcus aureus was identified in 86 positive swabs (approximately 94.5% of positive results).
- Beta-hemolytic streptococcus was detected in 10 positive swabs (approximately 11% of positive results).
Conclusions:
- Children with unrepaired cleft lip and palate exhibit a notable prevalence of Staphylococcus aureus carriage.
- There is a smaller but present risk of carrying beta-hemolytic streptococci.
- These findings underscore the importance of considering preoperative bacteriology testing and prophylactic antibiotic strategies.
Objective:
Bacterial infections can complicate any surgery. Knowledge of potentially pathogenic bacterial flora in children with cleft lip and palate allows appropriate risk management, including the need for prophylactic antibiotics. This project reviewed the bacteriology of children before primary cleft lip and palate surgery.
Design:
A retrospective study of the results of nose, throat, and ear microbiological swabs taken from children, aged 1 to 26 months, before repair of primary cleft lip, cleft palate, or both was carried out. Swabs with Staphylococcus aureus and beta-hemolytic streptococcus were considered positive.
Results:
From October 1987 to May 2002, 321 primary cleft lip or palate operations were performed in 250 patients. Results from 326 sets of preoperative swabs were available, including five repeat sets from patients whose operations were postponed. There were 235 (72.1%) negative sets and 91 (27.9%) positive sets. Of the positive swabs, 86 sets grew S. aureus, and 10 sets grew beta-hemolytic streptococcus.
Conclusions:
Children with unrepaired cleft lip and palate have a significant risk of carrying S. aureus and a small risk of carrying beta-hemolytic streptococci. These risks need to be considered when deciding on protocols for preoperative bacteriology tests and prophylactic antibiotics.
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