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Antibiotic Prophylaxis to Prevent Surgical Site Infections in Children: A Prospective Cohort Study
Amir Khoshbin1, Jeannette P So, Ilyas S Aleem
1*Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada †Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; ‡Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada §Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Ontario, Canada ¶Center for Patient Safety, University of Toronto, Toronto, Ontario, Canada.
Insights
Adhering to antibiotic prophylaxis guidelines in pediatric surgery significantly reduces the risk of surgical-site infections (SSIs). Proper antibiotic use is crucial for improving patient outcomes and preventing postoperative complications.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Clinical Outcomes Research
Background:
- Surgical-site infections (SSIs) are a significant cause of morbidity and mortality in pediatric patients.
- The efficacy of antibiotic prophylaxis (AP) in preventing SSIs in children remains uncertain despite adult studies.
Purpose of the Study:
- To determine the association between adherence to antibiotic prophylaxis guidelines and the incidence of surgical-site infections in pediatric surgical patients.
- To evaluate the impact of complete compliance with AP on reducing SSI rates in a pediatric population.
Main Methods:
- A retrospective study assessed pediatric patients (0-21 years) undergoing surgery between April 2009 and December 2010.
- Data on AP indication, administration timing, and SSI occurrence (using CDC criteria) were collected.
- Logistic regression analysis adjusted for multiple patient and surgical factors to assess AP compliance and SSI association.
Main Results:
- Complete compliance with AP (when indicated) was associated with a 30% reduction in SSI risk (adjusted relative risk: 0.7; P = 0.02).
- Patients with complete AP compliance had a 3.0% infection rate versus 4.3% in non-compliant patients.
- Antibiotic administration when not indicated showed no significant increase or decrease in SSI rates.
Conclusions:
- Complete compliance with antibiotic prophylaxis guidelines is associated with a significantly decreased risk of surgical-site infections in pediatric surgery.
- Adherence to evidence-based AP protocols is critical for improving surgical safety and patient outcomes in pediatric populations.
Objective:
To investigate the association between antibiotic prophylaxis (AP) and surgical-site infection in pediatric patients.
Background:
Surgical-site infections (SSIs) are a major cause of postoperative morbidity and mortality. Despite numerous studies in adults, benefit of AP in preventing SSIs in children is uncertain.
Methods:
Patients aged 0 to 21 years who underwent surgical procedures at a pediatric acute care hospital from April 1, 2009, to December 31, 2010, were assessed. Antibiotic prophylaxis indication and administration according to an evidence-based guideline were recorded. Complete compliance was defined as AP given, when indicated, within 60 minutes before incision. Surgical-site infections were identified using the Centers for Disease Control and Prevention criteria and documented in the medical records using the International Classification of Diseases, Tenth Revision. Multiple logistic regressions adjusting for age, sex, American Society of Anesthesiologists status, wound classification, admission status, surgical discipline, and surgical duration evaluated association of AP compliance and SSI.
Results:
Of 5309 patients for whom antibiotics were indicated, 3901 (73.5%) with complete compliance had an infection rate of 3.0%, whereas 1408 (26.5%) who were not compliant had an infection rate of 4.3% (adjusted relative risk: 0.7; 95% confidence interval: 0.5-0.9; P = 0.02). Of 4156 patients for whom antibiotics were not indicated, the 895 (21.5%) who received antibiotics had an infection rate of 1.7% compared with 0.7% in the 3261 (78.5%) who did not receive antibiotics (adjusted relative risk: 1.6; 95% confidence interval: 0.8-3.1; P = 0.18).
Conclusions:
In pediatric surgery, complete compliance with AP was associated with 30% decreased risk of SSI.
