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Surgical Antimicrobial Prophylaxis in Neonates and Children with Special High-Risk Conditions: A RAND/UCLA
Sonia Bianchini1, Erika Rigotti2, Laura Nicoletti1
1Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
Insights
This consensus document provides optimal surgical antimicrobial prophylaxis (SAP) guidelines for high-risk pediatric patients to reduce surgical site infections (SSIs) and antimicrobial resistance. It addresses specific conditions like MRSA colonization and immunosuppression for improved patient outcomes.
Area of Science:
- Infectious Diseases
- Pediatric Surgery
- Antimicrobial Stewardship
Background:
- Surgical site infections (SSIs) are significant complications in pediatric surgery, leading to increased morbidity, mortality, and healthcare costs.
- Limited data exists on SSI risk factors and prophylaxis in pediatric patients, especially those with underlying conditions.
- Current antibiotic prescribing practices for SSIs in children often lack standardization and rely on individual opinions.
Purpose of the Study:
- To establish a consensus document defining optimal surgical antimicrobial prophylaxis (SAP) for neonates and children with specific high-risk conditions.
- To address the scarcity of pediatric-specific guidelines for SSI prevention in vulnerable populations.
- To provide evidence-based recommendations for perioperative antibiotic use in high-risk pediatric surgical patients.
Main Methods:
- Development of a consensus document by a multidisciplinary team of experts from major Italian scientific societies.
- Identification of specific high-risk categories in pediatric surgical patients, including colonization (MRSA, MDR bacteria), allergies, immunosuppression, splenectomy, comorbidities, and prior healthcare exposures.
- Review and synthesis of existing literature and clinical expertise to formulate recommendations.
Main Results:
- The consensus document outlines optimal SAP strategies for neonates and children facing specific high-risk conditions.
- Key high-risk factors identified include MRSA/MDR colonization, antibiotic allergies, immunosuppression, splenectomy, comorbidities, and recent healthcare exposure.
- The recommendations aim to standardize perioperative antimicrobial use in these vulnerable pediatric groups.
Conclusions:
- Implementing uniform SAP protocols for high-risk pediatric surgical patients can significantly reduce SSIs.
- Standardized prophylaxis improves surgical practice, rationalizes healthcare resource utilization, and lowers costs.
- Adherence to these guidelines can contribute to limiting the development and spread of antimicrobial resistance.
Abstract:
Surgical site infections (SSIs), which are a potential complications in surgical procedures, are associated with prolonged hospital stays and increased postoperative mortality rates, and they also have a significant economic impact on health systems. Data in literature regarding risk factors for SSIs in pediatric age are scarce, with consequent difficulties in the management of SSI prophylaxis and with antibiotic prescribing attitudes in the various surgical procedures that often tend to follow individual opinions. The lack of pediatric studies is even more evident when we consider surgeries performed in subjects with underlying conditions that may pose an increased risk of complications. In order to respond to this shortcoming, we developed a consensus document to define optimal surgical antimicrobial prophylaxis (SAP) in neonates and children with specific high-risk conditions. These included the following: (1) colonization by methicillin-resistant Staphylococcus aureus (MRSA) and by multidrug resistant (MDR) bacteria other than MRSA; (2) allergy to first-line antibiotics; (3) immunosuppression; (4) splenectomy; (5) comorbidity; (6) ongoing antibiotic therapy or prophylaxis; (7) coexisting infection at another site; (8) previous surgery in the last month; and (9) presurgery hospitalization lasting more than 2 weeks. This work, made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, represents, in our opinion, the most up-to-date and comprehensive collection of recommendations relating to behaviors to be undertaken in a perioperative site in the presence of specific categories of patients at high-risk of complications during surgery. The application of uniform and shared protocols in these high-risk categories will improve surgical practice with a reduction in SSIs and consequent rationalization of resources and costs, as well as being able to limit the phenomenon of antimicrobial resistance.
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