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Outcome of restricted antibiotic policy in a tertiary-level paediatric surgical unit

Mamatha Basavaraju1, Anand Alladi1, Deepti Vepakomma1

  • 1Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.

African Journal of Paediatric Surgery : AJPS
|February 17, 2021
PubMed

Insights

A restrictive antibiotic policy, including no antibiotics for clean surgeries and a single dose for clean-contaminated procedures, did not increase surgical-site infections (SSI) in children. This approach is effective for pediatric surgical patients.

Area of Science:

  • Pediatric surgery
  • Infectious disease prevention
  • Antibiotic stewardship

Background:

  • Antibiotic prophylaxis (AP) is standard for preventing surgical-site infections (SSI).
  • Restrictive antibiotic policies aim to reduce antibiotic use while maintaining efficacy.
  • The optimal AP strategy for pediatric clean and clean-contaminated surgeries requires evaluation.

Purpose of the Study:

  • To assess the impact of a restrictive antibiotic policy on SSI rates in pediatric clean and clean-contaminated surgeries.
  • To compare outcomes of a no-antibiotic or single-dose pre-operative AP protocol against a traditional 3-5 day AP course.

Main Methods:

  • A prospective study of 933 children undergoing clean or clean-contaminated surgery with a restrictive AP protocol (no antibiotic or single dose).
  • Comparison with 676 historical controls who received 3-5 days of AP.
  • Outcomes assessed included SSI and organ-specific infections.

Main Results:

  • No statistically significant difference in infective outcomes was observed between the restrictive AP group and the historical control group for either clean or clean-contaminated surgeries.
  • This finding held true across subgroups including urological, gastrointestinal, and neurosurgeries.

Conclusions:

  • Antibiotic prophylaxis is not necessary for pediatric clean surgeries.
  • A single pre-operative dose of antibiotic prophylaxis is sufficient for preventing SSI in pediatric clean-contaminated surgeries.
Abstract

Keywords:
Clean contaminated woundclean woundrestrictive antibiotic policysurgical antibiotic prophylaxis surgical-site infection

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