Appropriate Prophylactic Antibiotics (Prophy-Abx) in Reducing Surgical Site Infections (SSIs) in Pediatric Patients Undergoing Cardiovascular Surgery (CVS) at Children's National Medical Center (CNMC) in Washington, DC

Background: Appropriate use of Prophy-Abx has demonstrated favorable results in reducing SSIs among adults, but its impact on pediatric patients remains unclear.

Methods: A 1:4 matched case-control study was conducted in children with congenital anomalies undergoing CVS repair between 1/1/2005 and 9/31/2006. SSI was identified based on physician diagnosis, clinical symptoms, and/or wound culture(s). Cases were individually matched to four controls selected from non-SSI patients based on surgery date and type of surgery. Appropriate Prophy-Abx was defined as administering 1st dose of cefazolin within 1 hour or 1st dose of vancomycin within 2 hours prior to the initial surgical incision.

Results: Compared to controls (n=84), cases (n=21) were more likely to be newborns (≤28 days) and disproportionately male. 90% and 7% of patients received cefazolin and vancomycin, respectively, as the 1st dose of Prophy-Abx, but only 80% were administered within the appropriate pre-operative period. Unadjusted analysis revealed that appropriate Prophy-Abx was not associated with reduced SSI risk (OR=0.66, p>0.05). Delayed primary sternal closure of surgical wound increased SSI risk by 15 times (OR=15.33, p=0.013). Adjusted analysis indicated that newborns, male gender, and delayed sternal closure independently increased SSI risk by 7 (OR=7.33, p=0.227), 4 (OR=3.65, p=0.076), and 6 times (OR=5.67, p=0.160), respectively, but the increase was not statistically significant.

Conclusions: In this small-sized preliminary study, we failed to detect a statistical association between appropriate Prophy-Abx and SSI. Further studies are warranted to determine if a bundle approach that includes both Prophy-Abx and post-operative wound care would lead to SSI reduction.