Prolonged antibiotic administration for surgical site infection in pediatric laryngotracheal surgery

Abstract

Objectives/Hypothesis: Incidence of surgical site infection (SSI) after laryngotracheal (LT) surgery is relatively high, especially in children. Study Design: Retrospective and prospective cohort study. Methods: Clinical records of children who underwent open LT surgery at the Istituto Giannina Gaslini Children's Hospital from January 2008 to August 2017 were reviewed for development of SSI. Standard antibiotic prophylaxis was administered until February 2015. In March 2015, an antibiotic treatment tailored on pathogens isolated from surveillance cultures and prolonged until extubation was introduced. Incidence and risk factors for SSI before and after the new protocol implementation were analyzed by means of univariate and multivariable analyses.Results: A total of 57 procedures were analyzed. SSI incidence was 36% in patients receiving standard prophylaxis and 4% in those treated with the new strategy (P = .004), with an absolute benefit increase of 32% (95% confidence interval: 11%-52%), in absence of any difference in clinical conditions between the two groups.Conclusions: The new management protocol had a highly favorable impact on the development of an SSI.

Pathogenic bacteria in bronchoalveolar lavage cultures and pediatric laryngotracheal reconstruction outcomes

“…The authors found a significant decrease in SSI with the tailored antibiotic regimen 10 . Based on the consistency between our results and previous findings, 10,11,13,15 we advocate for bacterial screening of the airway with culture directed treatment before airway reconstruction. We believe assessment of lower airway colonization via flexible bronchoscopy with BAL culture is the most effective diagnostic modality, supporting a multidisciplinary aerodigestive evaluation.…”

“…11 The authors prophylaxis and a culture-directed antibiotic protocol. 10 In the latter group, upper airway and tracheostomy swabs with either tracheal aspirate or BAL were obtained 10 days preoperatively. An antibiotic course was designed to begin 5 days before the procedure based on these results.…”

“…The presence of a tracheostomy predisposes children to colonization of pathogenic bacteria such as Pseudomonas aeruginosa and Staphylococcus aureus 8,9 . Open airway procedures are typically classified as clean‐contaminated given the exposure of the neck soft tissues to tracheal secretions 10 . Without antibiotic coverage, the risk of postoperative complications such as surgical site infections (SSI), graft loss, and dehiscence is increased 6,10–12 .…”

“…10 Without antibiotic coverage, the risk of postoperative complications such as surgical site infections (SSI), graft loss, and dehiscence is increased. 6,[10][11][12] Groups have described antibiotic protocols for pediatric airway reconstruction including alternate regimens based on colonization. 12 Typically, coverage includes P. aeruginosa and oral flora.…”

“…8,9 Open airway procedures are typically classified as clean-contaminated given the exposure of the neck soft tissues to tracheal secretions. 10 Without antibiotic coverage, the risk of postoperative complications such as surgical site infections (SSI), graft loss, and dehiscence is increased. 6,[10][11][12] Groups have described antibiotic protocols for pediatric airway reconstruction including alternate regimens based on colonization.…”