Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Undergoing Orthopedic and Hand Surgery: A RAND/UCLA Appropriateness Method Consensus Study
Francesca Opri,
Sonia Bianchini,
Laura Nicoletti,
Sara Monaco,
Roberta Opri,
Marilia Di Pietro,
Elena Carrara,
Erika Rigotti,
Cinzia Auriti,
Caterina Caminiti,
Daniele Donà,
Laura Lancella,
Andrea Lo Vecchio,
Simone Pizzi,
Nicola Principi,
Alessandro Simonini,
Simonetta Tesoro,
Eisabetta Venturini,
Alberto Villani,
Annamaria Staiano,
Leonardo Marchesini Reggiani,
Susanna Esposito,
on behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Group
Affiliations
Francesca Opri
Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy
Sonia Bianchini
Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
Laura Nicoletti
Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
Sara Monaco
Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
Roberta Opri
Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy
Marilia Di Pietro
Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy
Elena Carrara
Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
Erika Rigotti
Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy
Cinzia Auriti
Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy
Caterina Caminiti
Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy
Daniele Donà
Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy
Laura Lancella
Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy
Andrea Lo Vecchio
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy
Simone Pizzi
Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy
Nicola Principi
Università degli Studi di Milano, 20122 Milan, Italy
Alessandro Simonini
Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy
Simonetta Tesoro
Division of Anesthesia, Analgesia, and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy
Eisabetta Venturini
Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy
Alberto Villani
Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy
Annamaria Staiano
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy
Leonardo Marchesini Reggiani
Unit of Pediatric Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
Susanna Esposito
Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
on behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Group
Surgical site infections (SSIs) represent a potential complication in any type of surgery and can occur up to one year after the procedure in the case of implant placement. In the field of orthopedic and hand surgery, the rate of SSIs is a relevant issue, considering the need for the placement of synthesis devices and the type of some interventions (e.g., exposed fractures). This work aims to provide guidance on the management of peri-operative antibiotic prophylaxis for the pediatric and neonatal population undergoing orthopedic and hand surgery in order to standardize the management of patients and to reduce, on the one hand, the risk of SSI and, on the other, the development of antimicrobial resistance. The following scenarios were considered: (1) bloodless fracture reduction; (2) reduction of unexposed fracture and grade I and II exposed fracture; (3) reduction of grade III exposed fracture or traumatic amputation; (4) cruel fracture reduction with percutaneous synthesis; (5) non-traumatic amputation; (6) emergency intact skin trauma surgery and elective surgery without synthetic media placement; (7) elective orthopedic surgery with prosthetic and/or synthetic media placement and spinal surgery; (8) clean elective hand surgery with and without bone involvement, without use of synthetic means; (9) surgery of the hand on an elective basis with bone involvement and/or with use of synthetic means. This manuscript has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding the behavior to be adopted in the peri-operative setting in neonatal and pediatric orthopedic and hand surgery. The specific scenarios developed are aimed at guiding the healthcare professional in practice to ensure the better and standardized management of neonatal and pediatric patients, together with an easy consultation.
