Postoperative Wound Infection After Primary Closure in Pediatric Dog Bite Injuries

Guidelines recommend three to 5 d of antibiotic prophylaxis after dog bite injury, but variation exists in clinical practice after primary closure of wounds. The purpose of this study was to analyze antibiotic duration and incidence of infection during a study period in which an institutional protocol limiting postrepair antibiotics to a maximum of 3 d was implemented.

Dog bite injuries that underwent primary closure in patients ≤18 y were retrospectively identified from 2018 to 2022 at a level 1 pediatric trauma center. Demographic and clinical data were collected. Protocol compliance and short course of antibiotics were defined as ≤3 d of antibiotics. Multivariable regression analysis for variables associated with wound infection was performed.

455 injuries were included for analysis. After protocol implementation, the mean antibiotic duration decreased from 6.8 to 4.4 d (P < 0.001). Postrepair follow-up data were available for 235 (51.6%) cases in the cohort. Multivariable logistic regression identified superficial wounds and anatomic injury location to be significantly associated with wound infection. Shorter antibiotic duration was not associated with increased risk of wound infection on regression analysis, and there was no difference in postoperative wound infection rate between short-course and long-course groups (7.5% versus 7.1%, P = 0.912).

Standardization of postoperative antibiotic duration was associated with a decrease antibiotic duration without an increase in the incidence of wound infections after closure of dog bite wounds. This study highlights the feasibility of multidisciplinary standardization of pediatric trauma care across specialties and the safety of minimizing antibiotic duration after pediatric dog bite repairs.