Evaluation of Pediatric Surgical Site Infections Associated with Colorectal Surgeries at an Academic Children’s Hospital

Abstract

Appropriate use of antibiotic prophylaxis (AP) is a key measure for the prevention of surgical site infections (SSI) in colorectal surgeries; however, despite the presence of national and international guidelines, compliance with AP recommendations remains low. The purpose of this study is to evaluate compliance with recommendations for the use of AP in children undergoing colorectal surgeries and to evaluate the effectiveness of antibiotics in the prevention of SSI. We collected demographic and clinical characteristics of patients who underwent colorectal surgeries, as well as microbiological and antimicrobial susceptibility data for patients who developed SSI. AP data were collected and compared with national guidelines. Antibiotic dosing and duration were most frequently in concordance with national guidelines, while antibiotic timing and selection had the lowest rates of compliance. Twelve of the 192 colorectal procedures evaluated resulted in SSI. Only 2 of the 12 children with SSI received appropriate AP for all four categories evaluated. Eight cases that resulted in SSI were due to organisms not covered by the recommended AP. We identified multiple areas for the improvement of AP in children undergoing colorectal surgery. A multidisciplinary approach to development of standardized protocols, educational interventions, and EHR-based algorithms may facilitate or improve appropriate AP use.

Implementing the Protocol of Perioperative Narrow-spectrum Antibiotic Prophylaxis in the Surgical Wards of Mofid Children’s Hospital in 2019 - 2020, A Comparative Study

“…In our study, the number of dirty wounds was higher due to the fact that our center was a referral hospital. In a study in USA in 2020 on colorectal procedures, the percentages of clean/contaminated, contaminated, and dirty wounds were 68%, 17%, and 15%, respectively, showing a higher value in the case of contaminated wounds compared to our study because of the nature of their procedure (20).…”

Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention

“…The most frequently detected pathogens detected in pediatric and neonatal SSIs are shown in Table 3 [22,27,29,32,33,[38][39][40][41]43]. 1 Some patients had cultures positive for more than one bacteria species.…”

“…A single centre study carried out in Arkansas (USA) reported a 6.25% rate of SSI in children who had undergone colorectal surgery. Emergent surgery was burdened with a higher risk of SSI, as well as longer-lasting surgeries and hyperglycaemia [ 27 ].…”

“…On the other hand, the duration of the procedure and abdominal procedures were both associated with a higher risk of SSI. It must be noted, as reported by the authors themselves, that the small study sample may have affected the results of the study [ 27 ].…”

Peri-Operative Care

“…In this issue, Pough and colleagues explore variations in antibiotic administration and compliance with prophylaxis standards and identify opportunities for further reductions in surgical site infection in pediatric colorectal surgery populations [ 3 ]. They identify an approach to address these consistent with ERAS ® protocols.…”