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[Comparison between two antibiotic schemes in relation to surgical site infection in children: a randomized clinical
Eduardo Bracho-Blanchet1, Juan Porras-Hernández, Roberto Dávila-Pérez
1Departamento de Cirugía General, Hospital Infantil de México "Federico Gómez", México, D.F., Mexico. eduardo@fambracho.org
Insights
Short-term antibiotic prophylaxis (AP) given 2 hours before surgery significantly reduced surgical site infections (SSIs) in pediatric clean-contaminated procedures compared to traditional multi-day antibiotic regimens.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Clinical Trials
Background:
- Limited randomized clinical trials exist on antibiotic prophylaxis (AP) effectiveness for preventing pediatric surgical site infections (SSIs).
- This study aimed to compare AP effectiveness against traditional antibiotic schemes.
Purpose of the Study:
- To evaluate the efficacy of a 24-hour antibiotic prophylaxis regimen versus a 5-day traditional antibiotic scheme in preventing SSIs in pediatric patients.
Main Methods:
- A randomized clinical trial was conducted with 187 pediatric patients (≤18 years) undergoing clean or clean-contaminated procedures.
- The experimental group received 24-hour AP (cefalotin or clindamycin plus amikacin) starting 2 hours pre-incision.
- The control group received a 5-day traditional antibiotic regimen.
Main Results:
- The experimental group showed a significantly lower SSI incidence (1.2%) compared to the control group (10.9%) (RR 9.7, p=0.009).
- This reduction was primarily observed in clean-contaminated procedures.
- Sixteen patients were excluded from the analysis.
Conclusions:
- Administering antibiotic prophylaxis 2 hours before incision and continuing for 24 hours significantly reduces SSI risk in pediatric clean-contaminated procedures.
- This short-term AP regimen is more effective than traditional 5-day antibiotic schemes for preventing SSIs in this patient group.
Background:
There are few randomized clinical trials that prove the effectiveness of antibiotic prophylaxis (AP) to prevent pediatric surgical site infections (SSI). We undertook this study to determine the effectiveness of AP vs. traditional scheme of antibiotics.
Methods:
We carried out a randomized clinical trial at the General Surgery Department of a Tertiary Care Children's Hospital in Mexico City. There were 187 consecutive patients, age 18 years or less, with clean or clean-contaminated procedures performed between January 2005 and December 2006. Exclusion criteria included previous scar on operated site, receiving antibiotics, or no informed consent. Cefalotin or clindamycin plus amikacin was administered 2 h before incision, continued for just 24 h in the experimental group (EG) vs. cefalotin or clindamycin plus amikacin administered just before, during or after incision and continuing for 5 days (control group, CG).
Results:
Sixteen patients were excluded. EG included 26 clean and 54 clean-contaminated procedures, and in the CG there were 27 and 64 procedures, respectively. EG had a lower incidence of SSI (1/80 [1.2 %] vs. 10/91 [10.9 %], RR 9.7, (95% CI: 1.2-77.9, p = 0.009). The difference is based mainly on the clean-contaminated procedures.
Conclusions:
AP administered 2 h before incision and continuing for 24 h significantly decreases the risk of SSI compared to CG in clean-contaminated procedures.
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