Abstract
Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible since about 50% of SSIs occur after the hospital discharge. Gastrointestinal surgical procedures are among the surgical procedures with the highest risk of SSIs, especially when colon surgery is considered. Data that were collected from children seem to indicate that the risk of SSIs can be higher than in adults. This consensus document describes the use of preoperative antibiotic prophylaxis in neonates and children that are undergoing abdominal surgery and has the purpose of providing guidance to healthcare professionals who take care of children to avoid unnecessary and dangerous use of antibiotics in these patients. The following surgical procedures were analyzed: (1) gastrointestinal endoscopy; (2) abdominal surgery with a laparoscopic or laparotomy approach; (3) small bowel surgery; (4) appendectomy; (5) abdominal wall defect correction interventions; (6) ileo-colic perforation; (7) colorectal procedures; (8) biliary tract procedures; and (9) surgery on the liver or pancreas. Thanks to the multidisciplinary contribution of experts belonging to the most important Italian scientific societies that take care of neonates and children, this document presents an invaluable reference tool for perioperative antibiotic prophylaxis in the paediatric and neonatal populations.
Highlights
Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible since about 50% of SSIs occurs after the hospital discharge [1,2]
In clean procedures, the most common pathogens are those included in the skin flora, mainly Staphylococcus aureus and Staphylococcus epidermidis, whereas in clean-contaminated procedures, most of the cases are due to enteric Gram-negative rods, mainly Escherichia coli, Proteus spp., Klebsiella spp., enterococci and, in some cases, anaerobes, mainly Bacteroides and Clostridia [20]
As an example, when a cefazolin in combination with metronidazole was recommended, we considered cefotetan as an alternative
Summary
Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible since about 50% of SSIs occurs after the hospital discharge [1,2]. Data are not available in the paediatric population, it has been shown that adult patients with SSIs have a longer duration of hospitalization and, after discharge, frequently need emergency department visits, hospital readmission and, in rare cases, reoperation [3]. They have a 2–11 times greater risk of death than patients without SSI. The mean healthcare costs for a patient with SSI are approximately twice the costs for a patient without SSI [1,2,3]
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