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Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness
Susanna Esposito1, Rossella Sgarzani2, Sonia Bianchini1
1Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
Insights
Antimicrobial prophylaxis is recommended for select pediatric plastic surgery cases to reduce surgical site infections (SSIs). This consensus provides guidance to improve antibiotic use and limit antimicrobial resistance in children undergoing plastic surgery.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Infectious Disease
Background:
- Surgical site infections (SSIs) are a known complication of surgery.
- Existing antibiotic prophylaxis guidelines inadequately address pediatric plastic surgery.
- Children are often excluded from general surgical antibiotic prophylaxis recommendations.
Purpose of the Study:
- To provide evidence-based recommendations for antimicrobial prophylaxis in pediatric plastic surgery.
- To address specific scenarios in pediatric plastic surgery, including various wound types and procedures.
- To establish consensus guidelines for clinicians managing pediatric patients.
Main Methods:
- Consensus document development.
- Review of existing literature and guidelines.
- Consideration of diverse clinical scenarios in pediatric plastic surgery.
Main Results:
- Antimicrobial perioperative prophylaxis is recommended in selected pediatric plastic surgery cases.
- Guidelines cover scenarios from clean elective procedures to complex wound management and tissue expander insertion.
- The consensus aims to standardize practice and reduce SSIs.
Conclusions:
- Implementing shared protocols for antimicrobial prophylaxis can improve surgical practice in pediatric plastic surgery.
- Standardized prophylaxis may reduce SSIs, optimize resource utilization, and mitigate antimicrobial resistance.
- Further pediatric-specific studies are needed to refine recommendations.
Abstract:
For many years, it was clearly shown that surgical procedures might be associated with surgical site infection (SSI). Many scientific institutions prepared guidelines to use in surgery to reduce abuse and misuse of antibiotics. However, in the general guidelines for surgical antibiotic prophylaxis, plastic surgical procedures are not addressed or are only marginally discussed, and children were almost systematically excluded. The main aim of this Consensus document is to provide clinicians with recommendations on antimicrobial prophylaxis for pediatric patients undergoing plastic surgery. The following scenarios were considered: clean plastic surgery in elective procedures with an exclusive skin and subcutis involvement; clean-contaminated/contaminated plastic surgery in elective procedures with an exclusive skin and subcutis involvement; elective plastic surgery with use of local flaps; elective plastic surgery with the use of grafts; prolonged elective plastic surgery; acute burns; clean contused lacerated wounds without bone exposure; high-risk contused lacerated wounds or with bone exposure; contused lacerated wound involving the oral mucosa; plastic surgery following human bite; plastic surgery following animal bite; plastic surgery with tissue expander insertion. Our Consensus document shows that antimicrobial perioperative prophylaxis in pediatric patients undergoing plastic surgery is recommended in selected cases. While waiting the results of further pediatric studies, the application of uniform and shared protocols in these procedures will improve surgical practice, with a reduction in SSIs and consequent rationalization of resources and costs, as well as limiting the phenomenon of antimicrobial resistance.
