Outcome of restricted antibiotic policy in a tertiary-level paediatric surgical unit

Abstract

Purpose: The purpose was to evaluate the effect of a more restrictive antibiotic policy on infective complications, mainly surgical-site infection (SSI) in clean and clean contaminated surgeries in children.

Materials and methods: The study included children who underwent clean or clean contaminated surgeries over a period of 18 months with a no-antibiotic or single dose of pre-operative antibiotic protocol, respectively. These were compared to historical controls in previous 18 months where the antibiotic policy was to continue the course for 3-5 days. The outcome looked for was presence of SSI or infection related to the operated organ.

Results: A total of 933 (study group) patients were compared to 676 historic controls (control group). In the study group, 661 of 933 were clean surgeries and 272 were clean contaminated surgeries. In the study group, 490 of the 676 were clean surgeries and 186 were clean contaminated surgeries. Clean contaminated surgeries included urological surgeries, gastrointestinal tract surgeries and neurosurgeries, whereas clean surgeries were typically day-care surgeries. Comparing the infective outcomes in each type of surgery, there was no statistical difference between cases or controls in either subgroup.

Conclusion: Antibiotic prophylaxis (AP) is not required for clean surgeries. For clean contaminated surgeries, just one dose of pre-operative AP is effective in preventing SSI.

Keywords: Clean contaminated wound; clean wound; restrictive antibiotic policy; surgical antibiotic prophylaxis surgical-site infection.