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Additional prophylactic antibiotics do not decrease surgical site infection rates in pediatric patients with

Sarah C Stokes1, Christina M Theodorou1, Erin G Brown1

  • 1Department of Surgery, University of California-Davis, Sacramento, CA, USA.

Journal of Pediatric Surgery
|November 29, 2020
PubMed

Insights

For pediatric patients with acute intraabdominal infections already on treatment antibiotics, adding prophylactic antibiotics did not lower surgical site infection (SSI) rates. This suggests current antibiotic protocols may be sufficient for preventing SSIs in this population.

Area of Science:

  • Pediatric Surgery
  • Infectious Disease
  • Clinical Quality Improvement

Background:

  • Surgical site infections (SSI) are a concern in pediatric surgery.
  • Antibiotic administration within one hour of incision is a standard quality metric.
  • Many pediatric patients with acute intraabdominal infections receive treatment antibiotics prior to surgery.

Purpose of the Study:

  • To investigate whether additional prophylactic antibiotics reduce SSI rates in pediatric patients already receiving treatment antibiotics for acute intraabdominal infections.
  • To evaluate the impact of prophylactic antibiotics on SSI rates in pediatric appendectomy and cholecystectomy cases.

Main Methods:

  • Retrospective review of pediatric patients (<18 years) undergoing appendectomy or cholecystectomy between July 2014 and July 2019.
  • Patients were classified based on receiving additional prophylactic antibiotics for Gram-positive bacteria coverage within one hour of incision.
  • Primary outcome was SSI; secondary outcomes included Clostridium difficile colitis, allergic reactions, and infection-related readmissions.

Main Results:

  • No significant difference in organ space SSI rates (4.3% vs. 4.4%, p=0.97) or superficial SSI rates (1.1% vs. 0.7%, p>0.999) between groups.
  • One patient receiving prophylactic antibiotics was readmitted with Clostridium difficile colitis.
  • No significant differences were observed in intraoperative allergic reactions or readmission rates due to infection.

Conclusions:

  • Additional prophylactic antibiotics may not be necessary for pediatric patients already receiving treatment antibiotics for acute intraabdominal infections.
  • Current treatment antibiotic regimens appear adequate in preventing surgical site infections in this specific pediatric population.
Abstract

Keywords:
Antibiotic stewardshipAntibioticsAppendicitisCholecystitisPre-incision prophylaxis

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