What Is the Impact of Postoperative Antibiotic Prophylaxis on Tissue Expander Infection Rates in Pediatric Patients?

Abstract

Background: Tissue expansion in the pediatric population can be complicated by high rates of infection and extrusion. The aim of this study was to examine the impact of postoperative antibiotic prophylaxis on infectious complications. Methods: A retrospective study of all pediatric patients who underwent tissue expander insertion at a children's hospital over a 12-year period was performed. Predictor variables included age, sex, race, indication, anatomical location, number of expanders inserted, serial expansion, history of infection or extrusion, and postoperative antibiotics. Outcome variables included infection and extrusion. Bivariate and multivariate analyses were performed to identify factors associated with infection and/or extrusion. Results: A total of 180 patients who underwent 317 operations for tissue expander insertion were included in this study. Postoperative infection and/ or extrusion occurred after 73 operations (23 percent). Postoperative prophylactic antibiotics were prescribed after 232 operations (75 percent), and only perioperative (≤24 hours) antibiotics were administered in 85 cases (25 percent). There were no significant differences in the rate of infection (12.1 percent versus 8.9 percent; p = 0.46), extrusion (16.8 percent versus 17.7 percent; p = 0.88), or infection and/or extrusion (23.7 percent versus 24.1 percent; p = 0.95) between these two groups. Multivariate analysis revealed that postoperative antibiotics did not have a significant association with infection and/or extrusion (OR, 0.84; 95 percent CI, 0.44 to 1.63; p = 0.61). Conclusions:The rates of infection/extrusion were similar between pediatric patients who received only perioperative antibiotics (≤24 hours) and those who were prescribed a course of postoperative antibiotics. Based on these results, a course of postoperative prophylactic antibiotics may be unnecessary after insertion of tissue expanders in pediatric patients.

Complications Following Tissue Expander-Based Reconstruction in Pediatric Burn Injuries

“…These TEs were textured (n = 13, 46.4%) and varied in size. Of the TEs placed, 75% received their first inflation within a median (IQR) of 18 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) days (Table 3).…”

“…1). Patients who encountered wound complications, in comparison to those who did not, had a significantly greater median (IQR) % TBSA involved [35 (18-45), 19 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), P = 0.02], were more likely to have four inserted TEs [n = 2 (20%), n = 0 (0.0%), P = 0.03], and less likely to have only one inserted TE [n = 2 (20.0%), n = 11 (61.1%), P = 0.03]. No significant association was observed between the type of TE (smooth vs textured) and any of the outcomes (Table 5).…”

“…Ten (36%) patients experienced wound complications, most commonly surgical site infection following TE placement [n = 6 (21%)]. Patients who experienced wound complications, compared to those who did not, had a significantly greater median (IQR) [19][20][21][22][23][24], P = 0.02]. Conclusion: Pediatric burn injuries involving greater than 30% TBSA and necessitating an increasing number of TEs were associated with worse postoperative complications following TE-based reconstruction.…”

“…3 Postoperative complications following TE-based reconstruction in pediatric burn patients include infection, seroma, extrusion, and premature explantation. 16,[18][19][20][21] The most commonly reported complication is infection, presenting a significant impediment to successful reconstructive outcomes and further extending the reconstructive process. [16][17][18][19][22][23][24] Several risk factors for these postoperative complications have been reported in the literature, including large total body surface area (TBSA) burns, deep burns, and patients' overall health.…”

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

“…The Infectious Disease Society of America stated that when antibiotic prophylaxis is administered, ideally, the first dose should be given parenterally to achieve effective tissue levels as quickly as possible [73]. Therapeutic alternatives are numerous in the literature: ampicillin-sulbactam is the drug of choice for the starting dose in children; amoxicillin-clavulanate is the recommended oral drug [73,82].…”