Abstract
Objective: Evidence for the duration of perioperative antibiotic prophylaxis (PAP) after the correction of craniosynostosis in children is scarce. We evaluated the necessary duration of PAP to ensure a minimal rate of postoperative wound infections.Methods: In this monocentric, retrospective, and prospective pilot study, two PAP protocols were compared. From August 2017 to May 2018, treatment group 1 (TG 1) was treated using the standard PAP protocol with at least three doses of antibiotics. Between May 2018 and March 2019, a shortened PAP with a single-shot administration was given to treatment group 2 (TG 2a and b). Endpoints of this study were wound infection rate, colonization rate of wound drains, and the course of treatment reflected by clinical and laboratory data.Results: A cohort of 187 children underwent craniosynostosis correction: 167 were treated according to protocols-−95 patients with at least three doses (TG 1) and 72 patients with a single-shot of cefuroxime (TG 2a). Baseline characteristics were similar for both groups. We could not detect significant differences, neither for wound infection rates (TG 1: 1.1%, TG 2a: 0.0%, p = 0.38) nor for colonization rates of wound drains (TG 1: 4.8%, TG 2a: 10.5%, p = 0.27).Conclusions: Single-shot PAP had no adverse effects on the wound infection rate or the colonization rate of the wound drains compared with prolonged perioperative antibiotic prophylaxis. As a result, single-shot preoperative PAP is now applied to the majority craniosynostosis patients undergoing surgical correction in our unit.
Highlights
Craniosynostosis, defined as premature fusion of one or more cranial sutures, is rare in children with an estimated prevalence of 3 to 7.2 per 10,000 live births [1,2,3,4]
To avoid peri- and postoperative complications, especially wound infections and impaired wound healing, perioperative antibiotic prophylaxis is routinely administered to these children
187 children after craniosynostosis surgery were evaluated for this study
Summary
Craniosynostosis, defined as premature fusion of one or more cranial sutures, is rare in children with an estimated prevalence of 3 to 7.2 per 10,000 live births [1,2,3,4]. The indication for a surgical intervention is based on the extent of the associated phenotype. Because surgical correction is routinely performed in infancy, an early diagnosis as well as a tailored treatment approach, are of paramount importance. To avoid peri- and postoperative complications, especially wound infections and impaired wound healing, perioperative antibiotic prophylaxis is routinely administered to these children. Recommendations for perioperative antibiotic prophylaxis (PAP) for children undergoing craniosynostosis correction can be based mainly on retrospective surveys and cohort studies [5]. In the context of antibiotic stewardship and to avoid an inappropriate use of antibiotics, prospective clinical trials are necessary to allow PAP recommendation based on solid evidence
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