Role of prophylactic antibiotics in preventing postoperative wound infection in clean surgeries: a comparative study

Tamanna Ferdousi; Kazi M. Noor-ul Ferdous; Sadia Sultana; Umama Huq

doi:10.18203/2349-3291.ijcp20253775

Authors

Tamanna Ferdousi Department of Pediatrics Surgery, KPJ Specialized Hospital and Nursing College, Dhaka, Bangladesh
Kazi M. Noor-ul Ferdous Department of Pediatric and Neonatal Surgery, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
Sadia Sultana Department of Pediatric Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
Umama Huq Department of Pediatric Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-3291.ijcp20253775

Keywords:

Prophylactic antibiotics, Clean surgery, Surgical site infection

Abstract

Background: The role of prophylactic antibiotics in clean surgeries remains controversial in the pediatric population. Despite guidelines discouraging routine use, many surgeons prescribe them due to concerns regarding surgical site infections (SSIs). This study evaluated whether perioperative prophylactic antibiotics reduce postoperative wound infection in pediatric clean surgeries and assessed their cost implications.

Methods: This prospective, comparative interventional study was conducted at Bangladesh Shishu Hospital and Institute (Formar Dhaka Shishu Hospital) from March 2021 to September 2023. A total of 130 pediatric patients undergoing clean surgical procedures were randomly allocated into two groups: Group A (n=65) received a single-dose prophylactic antibiotic, and Group B (n=65) did not. Patients were followed up on the 3rd, 7th, and 30th postoperative days for signs of infection. Statistical analyses were performed using SPSS version 23.0, with a p value <0.05 considered significant.

Results: The mean age was 35.01±32.925 months in group A and 39.70±32.42 months in group B. The mean treatment cost was slightly higher in the antibiotic group (8526.25±900.10 BDT) than in the non-antibiotic group (8335.75±700.20 BDT). On the 7th postoperative day, one patient (1.5%) in the antibiotic group developed wound redness, swelling, serous discharge, and tenderness. No infection was recorded in the non-antibiotic group. By the 30th postoperative day, all the patients were healthy.

Conclusion: Prophylactic antibiotics are unnecessary in pediatric clean surgeries and do not reduce postoperative wound infections. Avoiding their use may reduce healthcare costs and support antimicrobial stewardship, without compromising patient outcomes.

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References

Cuschieri SA, Steele RJ. Patients with postoperative complications. Essential Surg Pract. 2000;1:422-3.

Leaper DJ. Wound infection. Bailey and Love's short practice of surgery. 2000:87-98.

Burke JP. Maximizing appropriate antibiotic prophylaxis for surgical patients: an update from LDS Hospital, Salt Lake City. Clin Infect Dis. 2001;33(2):78-83. DOI: https://doi.org/10.1086/321861

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infection Control & Hosp Epidemiol. 1999;20(4):247-80. DOI: https://doi.org/10.1086/501620

Cha HG, Kwon JG, Han HH, Eom JS, Kim EK. Appropriate prophylactic antibiotic use in clean wound surgery under local anesthesia. J Korean Med Sci. 2019;34(17):135. DOI: https://doi.org/10.3346/jkms.2019.34.e135

World Health Organization. Antimicrobial resistance: global report on surveillance. Geneva: WHO; 2014.

Ahmad M, Asghar I, Abbas S, Khan A, Mansoor MN. Antibiotic prophylaxis in clean general surgery. J Coll Phys Surg. 2007;17(8):462-4.

Mann CV, Russell RC, Bailey H, Love RJ. Bailey and Love's short practice of surgery. 1995.

Knight R, Charbonneau P, Ratzer E, Zeren F, Haun W, Clark J. Prophylactic antibiotics are not indicated in clean general surgery cases. The American J Surg. 2001;182(6):682-6. DOI: https://doi.org/10.1016/S0002-9610(01)00823-6

Joda AE. Are prophylactic antibiotics justified in pediatric patients with inguinal hernia repair. Mustansiriya Med J. 2016;15(2):24-9. DOI: https://doi.org/10.4103/2070-1128.247886

Khoshbin A, So JP, Aleem IS, Stephens D, Matlow AG, Wright JG, SickKids Surgical Site Infection Task Force. Antibiotic prophylaxis to prevent surgical site infections in children: a prospective cohort study. Ann Surg. 2015;262(2):397-402. DOI: https://doi.org/10.1097/SLA.0000000000000938

Yousuf M, Hussain M. Need and duration of antibiotic therapy in clean and clean contaminated operations. JPMA. The J Pakistan Med Assoc. 2002;52(7):284-7.

Kumar N, Gupta S, Pipariya PR. A comparative study to assess clinical outcome with or without receiving antibiotics in patients during post operative period in clean elective surgeries. J Med Sci Clin Res. 2019;7(5):268-72. DOI: https://doi.org/10.18535/jmscr/v7i5.43

Cohen MA, Chen CC. Evidence based cesarean section. Glob Libr Women’s Med. 2021;10. DOI: https://doi.org/10.3843/GLOWM.415553

Leuva HL, Khambholja JR, Nayak KK, Shah RC. Role of antibiotics in clean surgeries: Prophylaxis v/s. conventional. Gujarat Med J. 2014;69:96-8.

Prasanna PG, Ranganath H. A comparative study on antibiotics and no antibiotics in clean surgical cases; 2020.

Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. New England J Med. 1992;326(5):281-6. DOI: https://doi.org/10.1056/NEJM199201303260501