Prospective study of antibiotic protocols for managing surgical site infections in children

Surgical site infections in infants admitted to the neonatal intensive care unit

“…We were unable to compare outcomes based on the standard of practice for prophylactic antibiotics (PA) due to a lack of precision on the urgency of surgeries and lack of the data on the timing of peri-operative antibiotic administration. Ichikawa et al showed that a peri-operative protocol involving, among other changes, a shorter, better timed administration of PA resulted in a significant reduction of SSI, which may indicate a potential benefit from PA in preventing SSI [11]. The lack of standard regarding the timing of pre-operative antibiotics may explain the lack of detectable association with SSI in our study.…”

“…However, a major limitation of this earlier study is the inclusion of a very small number of preterm infants of lower gestational age (born <32 weeks; n = 68), which limits application of the data in a modern context of increased survival of VLBW infants [12]. According to our study, VLBW infants represent a significant proportion of infants who require surgical interventions and therefore, exclusion of these infants represents an important limitation of previous studies [11][12][13]. Furthermore although overall SSI rates were substantially higher in this earlier study (>16.6 %) compared to our data, these infants were managed before major improvements in neonatal and surgical care, which may have influenced the nature and/or risk of surgical interventions.…”

“…Previous studies in the pediatric age group included a limited number of neonates and infants, and did not discriminate risk based on the type of surgical intervention [10]. Some studies excluded significant neonatal risk groups such as very low birth weight (VLBW) infants [11][12][13]. Finally, other neonatal studies were performed in an ambulatory care setting or in resourcelimited countries [12,[14][15][16][17][18][19], which limits generalization of data to the neonatal intensive care setting where most high-risk interventions occur [10,20].…”

Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations

“…A controlled study by Ichikawa found baseline wound infection rates that varied by degree of contamination: 2.6% in clean-contaminated, 5.8% in contaminated, and 20.8% in dirty wounds [37]. In a study of 1,142 acute wounds, Lammers found an overall infection rate of 7.2%, although rates vary based on location [9].…”

Surgical Site Infection Rates and Risk Factors in Orthopedic Pediatric Patients in Madrid, Spain

“…5 Recent evidence suggests that HAIs can be prevented through implementation of evidence-based best practices. 7 Comparison of SSI rates over several years or among different groupings can help assess a new surgical technique or prophylaxis. Antibiotic protocols for the prevention of infections issued by the Centers for Disease Control and Prevention do not contain sections designed for children.…”