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Surgical site infections in neonates and infants: is antibiotic prophylaxis needed for longer than 24 h?

Lan T Vu1, Eric Vittinghoff, Kerilyn K Nobuhara

  • 1Department of Surgery, University of California, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0570, USA, lan.vu@ucsfmedctr.org.

Pediatric Surgery International
|May 9, 2014
PubMed

Insights

Extended antibiotic use beyond 24 hours did not reduce surgical site infections (SSI) in infants undergoing gastrointestinal surgery. Further research is needed to confirm these findings on antibiotic prophylaxis duration.

Area of Science:

  • Pediatric Surgery
  • Infectious Disease Control
  • Clinical Research Methodology

Background:

  • Surgical site infections (SSI) are a significant concern in pediatric gastrointestinal surgery.
  • The optimal duration of perioperative antibiotic prophylaxis in neonates and infants remains debated.

Purpose of the Study:

  • To evaluate if extending perioperative antibiotic use beyond 24 hours reduces SSI incidence in neonates and infants undergoing gastrointestinal surgery.
  • To identify risk factors for SSI in this patient population.

Main Methods:

  • Retrospective chart review of 732 neonates and infants undergoing clean-contaminated or contaminated gastrointestinal operations (1996-2006).
  • Analysis of patient and operation variables, antibiotic duration, and SSI within 30 days.
  • Statistical methods included standard covariate adjustment and propensity score matching to control for confounding by indication.

Main Results:

  • The overall incidence of SSI was 13%.
  • Propensity score matching showed no significant difference in SSI odds between patients receiving ≤24 hours versus >24 hours of postoperative antibiotics (OR 1.1, 95% CI 0.6-1.9).
  • Independent predictors of SSI included preoperative infection and re-operation through the same incision.

Conclusions:

  • Perioperative antibiotic prophylaxis exceeding 24 hours provided no additional protection against SSI in clean-contaminated and contaminated pediatric gastrointestinal operations.
  • An adequately powered randomized clinical trial is warranted to definitively assess the efficacy of longer antibiotic prophylaxis durations.
Abstract

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