Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness Method Consensus Study

Abstract

For many years, it was clearly shown that surgical procedures might be associated with surgical site infection (SSI). Many scientific institutions prepared guidelines to use in surgery to reduce abuse and misuse of antibiotics. However, in the general guidelines for surgical antibiotic prophylaxis, plastic surgical procedures are not addressed or are only marginally discussed, and children were almost systematically excluded. The main aim of this Consensus document is to provide clinicians with recommendations on antimicrobial prophylaxis for pediatric patients undergoing plastic surgery. The following scenarios were considered: clean plastic surgery in elective procedures with an exclusive skin and subcutis involvement; clean-contaminated/contaminated plastic surgery in elective procedures with an exclusive skin and subcutis involvement; elective plastic surgery with use of local flaps; elective plastic surgery with the use of grafts; prolonged elective plastic surgery; acute burns; clean contused lacerated wounds without bone exposure; high-risk contused lacerated wounds or with bone exposure; contused lacerated wound involving the oral mucosa; plastic surgery following human bite; plastic surgery following animal bite; plastic surgery with tissue expander insertion. Our Consensus document shows that antimicrobial perioperative prophylaxis in pediatric patients undergoing plastic surgery is recommended in selected cases. While waiting the results of further pediatric studies, the application of uniform and shared protocols in these procedures will improve surgical practice, with a reduction in SSIs and consequent rationalization of resources and costs, as well as limiting the phenomenon of antimicrobial resistance.

Complications Following Tissue Expander-Based Reconstruction in Pediatric Burn Injuries

“…Current antibiotic prophylaxis strategies may also require re-evaluation, possibly integrating alternative or adjunctive preventative measures. 36 Gosain et al found that the rate of major complications, defined as unplanned reoperation for expander removal, expander rupture, and exposure, was 41.5%. 33 Our study revealed a 39% rate of major complications, most commonly premature explantation due to infection and extrusion.…”

“…This observation indicates a potential need for further research into optimizing antibiotic regimens, potentially involving longer durations or tailored approaches based on wound cultures. Current antibiotic prophylaxis strategies may also require re-evaluation, possibly integrating alternative or adjunctive preventative measures 36 …”

Staphylococcal Infections and Neonatal Skin: Data from Literature and Suggestions for the Clinical Management from Four Challenging Patients

“…Furthermore, perioperative antibiotic prophylaxis should be administered when surgery is needed [ 42 ]. A multidisciplinary approach is highly recommended, including an infectious disease specialist and a plastic surgeon.…”

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

“…This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs, except the use of antibiotics, for which we refer to the specific papers of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Group [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children.…”