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Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Undergoing Orthopedic and Hand Surgery:
Francesca Opri1, Sonia Bianchini2, Laura Nicoletti2
1Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy.
Insights
This study provides guidelines for peri-operative antibiotic prophylaxis in pediatric orthopedic and hand surgery to reduce surgical site infections (SSIs) and antimicrobial resistance. It standardizes patient management across various surgical scenarios for better outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Surgery
- Infectious Disease Management
Background:
- Surgical site infections (SSIs) are a significant complication in orthopedic and hand surgery, particularly with implant placement.
- The incidence of SSIs is a concern in pediatric orthopedic procedures due to the use of fixation devices and complex interventions like open fractures.
- Standardizing antibiotic prophylaxis is crucial to mitigate SSI risk and combat antimicrobial resistance in this vulnerable population.
Purpose of the Study:
- To establish standardized guidelines for peri-operative antibiotic prophylaxis in pediatric and neonatal orthopedic and hand surgery.
- To reduce the incidence of surgical site infections (SSIs) in young patients undergoing these procedures.
- To minimize the development of antimicrobial resistance through optimized antibiotic use.
Main Methods:
- Development of evidence-based recommendations by a multidisciplinary panel of experts from leading Italian scientific societies.
- Categorization of surgical scenarios into nine distinct types, ranging from simple fracture reductions to complex reconstructive surgeries with synthetic material placement.
- Focus on peri-operative antibiotic prophylaxis strategies tailored to each specific surgical context.
Main Results:
- A comprehensive set of recommendations for peri-operative antibiotic prophylaxis across nine defined surgical scenarios in pediatric and neonatal orthopedic and hand surgery.
- Standardized protocols designed to guide healthcare professionals in clinical practice.
- Emphasis on optimizing antibiotic selection and duration to balance efficacy and resistance prevention.
Conclusions:
- The developed guidelines offer a standardized and up-to-date approach to peri-operative antibiotic prophylaxis for neonatal and pediatric orthopedic and hand surgery.
- Implementation of these recommendations aims to improve patient management and reduce SSI rates.
- The guidelines are intended to be a practical tool for healthcare providers, promoting consistent and effective infection control strategies.
Abstract:
Surgical site infections (SSIs) represent a potential complication in any type of surgery and can occur up to one year after the procedure in the case of implant placement. In the field of orthopedic and hand surgery, the rate of SSIs is a relevant issue, considering the need for the placement of synthesis devices and the type of some interventions (e.g., exposed fractures). This work aims to provide guidance on the management of peri-operative antibiotic prophylaxis for the pediatric and neonatal population undergoing orthopedic and hand surgery in order to standardize the management of patients and to reduce, on the one hand, the risk of SSI and, on the other, the development of antimicrobial resistance. The following scenarios were considered: (1) bloodless fracture reduction; (2) reduction of unexposed fracture and grade I and II exposed fracture; (3) reduction of grade III exposed fracture or traumatic amputation; (4) cruel fracture reduction with percutaneous synthesis; (5) non-traumatic amputation; (6) emergency intact skin trauma surgery and elective surgery without synthetic media placement; (7) elective orthopedic surgery with prosthetic and/or synthetic media placement and spinal surgery; (8) clean elective hand surgery with and without bone involvement, without use of synthetic means; (9) surgery of the hand on an elective basis with bone involvement and/or with use of synthetic means. This manuscript has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding the behavior to be adopted in the peri-operative setting in neonatal and pediatric orthopedic and hand surgery. The specific scenarios developed are aimed at guiding the healthcare professional in practice to ensure the better and standardized management of neonatal and pediatric patients, together with an easy consultation.
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