Perioperative antibiotic prophylaxis in pediatric vertebrology: short or long course?

Introduction. Infectious complications in spine surgery occur in 0.6–17.6% of cases and are associated with high treatment costs. Perioperative antibiotic prophylaxis is considered to be an effective preventive measure. However, there are no clear recommendations for its use in children, including the optimal duration of antibiotic administration. This study presents a retrospective analysis of the impact of different perioperative antibiotic prophylaxis regimens on infection rates and the length of hospitalization.

The objective was to evaluate the effectiveness of different perioperative antibiotic prophylaxis regimens in pediatric patients undergoing spinal surgery.

Materials and methods. A retrospective study was conducted involving 319 children (aged 1–18 years) who underwent elective spine surgeries at the H.Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery. The patients were divided into two groups: the main group (perioperative prophylaxis ≥ 72 hours, n = 205) and the control group (perioperative prophylaxis ≤ 48 hours, n = 114). Antibiotics were administered intravenously 30–60 minutes before skin incision in all cases. The effectiveness of perioperative antibiotic prophylaxis was assessed based on clinical and laboratory data and local signs of infection at the surgical site.

Results. The average length of hospitalization was shorter in the short-protocol perioperative antibiotic prophylaxis group (21.29 days vs. 25.22 days, p = 0.00005). Local inflammatory changes were not observed in the short-protocol group, whereas 13 cases were recorded in the prolonged-protocol group (p = 0.0053). The results suggest the effectiveness of the short protocol of perioperative antibiotic prophylaxis.

Conclusion. Surgical site infection is a common and serious complication after spinal surgery in children. Adequate perioperative antibiotic prophylaxis plays a crucial role in reducing the risks of infectious complications. However, clear guidelines accounting for the anatomical and physiological characteristics of pediatric patients are lacking. Therefore, further studies are needed to develop a unified concept, which will significantly reduce the incidence of surgical site infections.

1. Aizenberg V. L., Ulrich G. E., Tsybin L. E., Zabolotsky D. V. Regional anesthesia in vertebrology. Regionarnaya anesteziya i lechenie ostroy boli. 2015, vol. 9, no. 4, pp. 38–49. (In Russ.).

2. Aslanov B. I., Zueva L. P., Kolosovskaya E. N. et al. Principles of organizing perioperative antibiotic prophylaxis in healthcare institutions. Federal Clinical Guidelines. National Association of Specialists in Infection Control Related to Healthcare. Moscow, 2014, 42 p. (In Russ.).

3. Babushkina I. V., Ulyanov V. Y., Bondarenko A. S., Mamonova I. A. Relative Ability to form Biofilms in Vitro of Staphylococcus Strains Isolated at Implant-Associated Infection and Inflammatory Complications Following Reconstructive Plastic Surgeries. Journal of Experimental and Clinical Surgery. 2019, vol. 12, no. 4, pp. 254–260. (In Russ.). http://doi.org/10.18499/2070-4 78X-2019-12-4-254-260.

4. Briko N. I., Bozhkova S. A., Brusina E. B. et al. Prevention of Surgical Site Infections. Clinical Guidelines. Nizhny Novgorod: Remedium Privolzhye, 2018, 72 p. (In Russ.).

5. Bozhkova S. A., Novokshonova A. A., Konev V. A. Current trends in local antibacterial therapy of periprosthetic infection and osteomyelitis. Traumatology and Orthopedics of Russia, 2015, vol. 21, no. 3, pp. 92–107. (In Russ.). http://doi.org/10.21823/2311-2905-2015-0-3-92-107.

6. Bozhkova S. A., Kasimova A. R., Tikhilov R. M. et al. Adverse Trends in the Etiology of Orthopedic Infection: Results of 6-Year Monitoring of the Structure and Resistance of Leading Pathogens. Traumatology and Orthopedics of Russia, 2018, vol. 24, no. 4, pp. 20–31. (In Russ.). http://doi.org/10.21823/2311-2905-2018-24-4-20-31.

7. Bozhkova S. A., Tikhilov R. M., Razorenov V. L. Microbiological Aspects of Antibacterial Therapy for Periprosthetic Infection Caused by Gram-Positive Pathogens. Infections in Surgery, 2011, vol. 9, no. 3, pp. 31–36. (In Russ.).

8. Gomon Y. M. Perioperative antibiotic prophylaxis: Budget impact analysis. Vestnik of Saint-Petersburg University. Medicine, 2018, vol. 3, no. 3, pp. 301–315. (In Russ.). http://doi.org/10.21638/11701/spbu11.2018.307.

9. Gordienko I. I., Tsap N. A. Perioperative Antibiotic Prophylaxis in Open Hand Injuries in Children. Doctor.Ru, 2019, vol. 5, no. 160, pp. 34–37. (In Russ.). http://doi.org/10.31550/1727-2378-2019-160-5-34-37.

10. Dobrokvashin S. V., Volkov D. E. Perioperative antibioticoprophylaxis in surgery. Kazan medical journal, 2004, vol. 85, no. 5, pp. 323–327. (In Russ.).

11. Zubkov D. S. Instructions for perioperative antimicrobial prophylaxis. Warning for those who want to prevent infection. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia), 2019, no. 1–2, pp. 6–12. (In Russ.).

12. Kovalishena O. V., Blagonravova A. S., Vorobyeva O. N. et al. Current issues of epidemiological surveillance of hospital infections. Remedium. The Volga region, 2008, no. 1 (61), pp. 49–51.

13. Yakovlev S. V. High-technology preoperative antibiotic prophylaxis in terms of surgery’s Fast-track concept. Doctor.Ru. Anesthesiology and Critical Care Medicine (Fast-track), 2016, no. 12 (129), pp. 43–48. (In Russ.).

14. Yakovlev S. V., Zhuravleva M. V., Protsenko D. N. et al. SCAT Programm (Strategy for Antimicrobial Therapy Control) in Inpatient Medical Care. Methodological Recommendations for Healthcare Institutions in Moscow. Consilium Medicum, 2017, vol. 19, pp. 15–51. (In Russ.).

15. Abdul-Jabbar A., Berven S. H., Hu S. S. et al. Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases // Spine (Phila Pa 1976). – 2013. – Vol. 38. – E1425–E1431. http://doi.org/10.1097/BRS.0b013e3182a42a68.

16. Algarny S., Perera A., Egenolf P. et al. Postoperative surgical site infections in spine surgery: can the duration of surgery predict the pathogen spectrum? // In Vivo. – 2023. – Vol. 37, № 4. – P. 1688–1693. http://doi.org/10.21873/in vivo.13255.

17. Amorim-Barbosa T., Sousa R., Rodrigues-Pinto R. et al. Risk factors for acute surgical site infection after spinal instrumentation procedures: a case-control study // International Journal of Spine Surgery. – 2021. – Vol. 15, № 5. – P. 1025–1030. http://doi.org/10.14444/8130.

18. Dona D., Luise D., Barbieri E. et al. Effectiveness and sustainability of an antimicrobial stewardship program for perioperative prophylaxis in pediatric surgery // Pathogens. – 2020. – Vol. 9. – P. 490. http://doi.org/10.3390/pathogens9060490.

19. Dona D., Luise D., Pergola L. E. et al. Effects of an antimicrobial stewardship intervention on perioperative antibiotic prophylaxis in pediatrics // Antimicrobial Resistance and Infection Control. – 2019. – Vol. 8. – P. 13. http://doi.org/10.1186/s13756-019-0464-z.

20. Floccari L. V, Milbrandt T. A. Surgical site infections after pediatric spine surgery // Orthopedic clinics. – 2015. – Vol. 47, № 2. – P. 387–394. http://doi.org/10.1016/j.ocl.2015.09.001

21. Khoshbin A., So J., Aleem I. et al. Antibiotic prophylaxis to prevent surgical site infections in children: a prospective cohort study // Annals of Surgery. – 2015. – Vol. 262, № 2. – P. 397–402. http://doi.org/10.1097/SLA.0000000000000938.

22. Lamret F., Colin M., Mongaret C. et al. Antibiotic tolerance of staphylococcus aureus biofilm in periprosthetic joint infections and antibiofilm strategies // Antibiotics (Basel). – 2020. – Vol. 9, № 9. – P. 547. http://doi.org/10.3390/antibiotics9090547.

23. Li Y., Glotzbecker M., Hedequist D. Surgical site infection after pediatric spinal deformity surgery // Curr Rev Musculoskelet Med. – 2012. – Vol. 5, № 2. – P. 111–119. http://doi.org/10.1007/s12178-012-9111-5.

24. Li C., Renz N., Trampuz A. Management of periprosthetic joint infection // Hip Pelvis. – 2018. – Vol. 30, № 3. – P. 138–146. http://doi.org/10.5371/hp.2018.30.3.138.

25. Maesani M., Doit C., Lorrot M. et al. Surgical Site infections in pediatric spine surgery: comparative microbiology of patients with idiopathic and nonidiopathic etiologies of spine deformity // The Pediatric Infectious Disease Journal. – 2016. – Vol. 35, № 1. – P. 66–70. http://doi.org/10.1097/INF.0000000000000925.

26. Maisat W., Yuki K. Surgical site infection in pediatric spinal fusion surgery revisited: outcome and risk factors after preventive bundle implementation // Perioper Care Oper Room Manag. – 2023. – 100308. http://doi.org/10.1016/j.pcorm.2023.100308.

27. Masters E. A., Trombetta R. P., de Mesy Bentley K. L. et al. concepts in bone infection: redefining “biofilm”, “acute vs. chronic osteomyelitis”, “the immune proteome” and “local antibiotic therapy” // Bone Res. – 2019. – Vol. 7. – P. 20. http://doi.org/10.1038/s41413-019-0061-z.

28. Milstone A. M., Maragakis L. L., Townsend T. et al. Timing of preoperative antibiotic prophylaxis: a modifiable risk factor for deep surgical site infections after pediatric spinal fusion // Pediatr Infect Dis J. – 2008. – Vol. 27, № 8. – P. 704–708. http://doi.org/10.1097/INF.0b013e31816fca72.

29. Shaffer A., Naik A., MacInnis B. et al. Perioperative prophylaxis for surgical site infections in pediatric spinal surgery: a systematic review and network meta-analysis // Journal of Neurosurgery: Pediatrics. – 2023. – Vol. 31, № 1. – P. 43–51. http://doi.org/10.3171/2022.9.PEDS22316.

30. Schwenk H. T., Bio L. L. Hidden no more: capturing the full picture of prolonged perioperative antibiotic prophylaxis // Hospital pediatrics. – 2022. – http://doi.org/10.1542/hpeds.2021-006409

31. Takemoto R. C., Lonner B., Andres T. et al. Appropriateness of twenty-four-hour antibiotic prophylaxis after spinal surgery in which a drain is utilized: a prospective randomized study // J Bone Joint Surg Am. – 2015. – Vol. 97, № 12. – P. 979–986. http://doi.org/10.2106/JBJS.L.00782.

32. White A. J., Fiani B., Jarrah R. et al. Surgical site infection prophylaxis and wound management in spine surgery // Asian Spine J. – 2022. – Vol. 16, № 3. – P. 451–461. http://doi.org/10.31616/asj.2020.0674.