Ichikawa Satoko, Ishihara Mihoko, Okazaki Tadaharu, Warabi Kengo, Kato Yoshifumi, Hori Satoshi, Lane Geoffrey J, Hiramatsu Keiichi, Inada Eiichi, Kobayashi Hiroyuki, Yamataka Atsuyuki
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
J Pediatr Surg. 2007 Jun;42(6):1002-7; discussion 1007. doi: 10.1016/j.jpedsurg.2007.01.034.
We adopted antibiotic (Ab) protocols for managing surgical site infections in children and assessed their effectiveness.
We used our protocols on 1313 children between 2004 and 2005. All wounds were monitored for 30 days and classified as clean, clean-contaminated, contaminated, or dirty-infected. Infections were defined as superficial, deep, or organ/space. A retrospective study involving 721 children who had surgery in 2003 was also performed. Chi2 statistical analysis was performed.
Postprotocol, all Abs were administered accurately by anesthesiologists and infections developed in only 22 cases (1.7%): 0.2% (clean), 2.6% (clean-contaminated), 5.8% (contaminated), and 20.8% (dirty-infected), respectively; 21 were superficial or deep and 1 was organ/space. Age at surgery and sex did not influence incidence, neither did length of surgery for clean-contaminated, contaminated, and dirty-infected wounds; clean wounds were excluded because all surgery was minor. Overall, incidence of infections was 1.2% for elective surgery and 4.5% for emergency surgery (P < .01). Preprotocol, only 67% had Ab and infections developed in 27 cases (3.7%), which is significantly higher than in postprotocol (P < .01).
Accurate administration of Ab and careful supervision by an infection control team appear to be effective for preventing wound infections in children.
我们采用抗生素方案来管理儿童手术部位感染，并评估其有效性。
2004年至2005年期间，我们对1313名儿童使用了该方案。所有伤口均监测30天，并分为清洁、清洁-污染、污染或脏污-感染四类。感染分为浅表、深部或器官/腔隙感染。我们还对2003年接受手术的721名儿童进行了回顾性研究。进行了卡方统计分析。
采用方案后，麻醉医生准确使用了所有抗生素，仅22例（1.7%）发生感染：清洁伤口感染率为0.2%，清洁-污染伤口为2.6%，污染伤口为5.8%，脏污-感染伤口为20.8%；21例为浅表或深部感染，1例为器官/腔隙感染。手术年龄和性别不影响感染发生率，清洁-污染、污染和脏污-感染伤口的手术时长也不影响；清洁伤口因均为小手术而被排除。总体而言，择期手术感染发生率为1.2%，急诊手术为4.5%（P <.01）。采用方案前仅67%使用了抗生素，27例（3.7%）发生感染，显著高于采用方案后（P <.01）。
准确使用抗生素并由感染控制团队进行仔细监督似乎对预防儿童伤口感染有效。
