Abstract
Surgical site infections (SSIs), which are a potential complications in surgical procedures, are associated with prolonged hospital stays and increased postoperative mortality rates, and they also have a significant economic impact on health systems. Data in literature regarding risk factors for SSIs in pediatric age are scarce, with consequent difficulties in the management of SSI prophylaxis and with antibiotic prescribing attitudes in the various surgical procedures that often tend to follow individual opinions. The lack of pediatric studies is even more evident when we consider surgeries performed in subjects with underlying conditions that may pose an increased risk of complications. In order to respond to this shortcoming, we developed a consensus document to define optimal surgical antimicrobial prophylaxis (SAP) in neonates and children with specific high-risk conditions. These included the following: (1) colonization by methicillin-resistant Staphylococcus aureus (MRSA) and by multidrug resistant (MDR) bacteria other than MRSA; (2) allergy to first-line antibiotics; (3) immunosuppression; (4) splenectomy; (5) comorbidity; (6) ongoing antibiotic therapy or prophylaxis; (7) coexisting infection at another site; (8) previous surgery in the last month; and (9) presurgery hospitalization lasting more than 2 weeks. This work, made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, represents, in our opinion, the most up-to-date and comprehensive collection of recommendations relating to behaviors to be undertaken in a perioperative site in the presence of specific categories of patients at high-risk of complications during surgery. The application of uniform and shared protocols in these high-risk categories will improve surgical practice with a reduction in SSIs and consequent rationalization of resources and costs, as well as being able to limit the phenomenon of antimicrobial resistance.
Highlights
Surgical site infections (SSIs), which are a potential complication in surgical procedures, are associated with prolonged hospital stays and increased postoperative mortality rates, and they have a significant economic impact on health systems [1,2]
The development of multiresistant bacteria to antimicrobial therapy (MDR), i.e., bacteria not susceptible to at least one agent in three or more classes of antimicrobial drugs [8], is an ever-growing phenomenon associated with high morbidity and mortality in both adults and children [9]
Among multidrug resistant (MDR) bacteria implicated in SSIs, a central role is played by S. aureus, in cases where the pathogen is resistant to methicillin (MRSA) [10]
Summary
Surgical site infections (SSIs), which are a potential complication in surgical procedures, are associated with prolonged hospital stays and increased postoperative mortality rates, and they have a significant economic impact on health systems [1,2]. In order to respond to this shortcoming, we developed a consensus document in order to define the optimal surgical antimicrobial prophylaxis (SAP) in neonates and children with specific high-risk conditions. These included the following: (1) colonization by methicillin-resistant Staphylococcus aureus (MRSA) and by multi-drug resistant (MDR) bacteria other than MRSA; (2) allergy to firstline antibiotics; (3) immunosuppression; (4) splenectomy; (5) comorbidity; (6) ongoing antibiotic therapy or prophylaxis; (7) coexisting infection at another site; (8) previous surgery in the last month; and (9) presurgery hospitalization lasting more than 2 weeks
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