Department of Pediatric Surgery, Children's Hospital Boston-Harvard Medical School, Boston, MA 02115, USA.
J Pediatr Surg. 2011 Feb;46(2):366-71. doi: 10.1016/j.jpedsurg.2010.11.016.
The use of surgical antibiotic prophylaxis (AP) in children is poorly characterized. The aims of this study were to examine (1) trends in the use of AP for commonly performed operations, (2) appropriateness in the context of available guidelines, and (3) adverse events potentially attributable to AP.
We conducted a 5-year retrospective analysis of 22 children's hospitals (January 2005-March 2009) for all patients younger than 18 years who underwent 1 of the 40 commonly performed general and urological procedures. Indications for AP were defined by published specialty-specific guidelines. Clostridium difficile infection and surrogate events for drug allergy (diphenhydramine and epinephrine administrations) were examined as potential antibiotic-associated adverse events.
Procedures of 246,316 were identified, of which 25% met criteria for AP. Eighty-two percent of the children received antibiotics during procedures when AP was indicated (range, 60%-96% by hospital), and 40% of the patients received antibiotics when there was no indication (range, 10%-83%). The likelihood of receiving AP was significantly different between hospitals for all procedures examined (P < .0001 for each procedure). Adverse events were significantly more frequent in children receiving AP than in those who did not (odds ratio [95% confidence interval] C difficile: 18.8 [6.9-51.5], P < .0001; epinephrine: 1.8 [1.7-2.0], P < .0001; diphenhydramine: 6.0 [5.6-6.5], P < .0001).
Significant variation exists in the use of AP in the pediatric surgical population. Many children do not receive AP when indicated, and an even greater proportion may receive antibiotics when there is no indication. These findings may have profound implications from a public health perspective when extrapolated to all children undergoing surgical procedures.
外科预防性使用抗生素（AP）在儿童中的应用情况描述不足。本研究的目的是：（1）研究常用于手术的 AP 使用趋势；（2）根据现有指南评估其合理性；（3）评估可能与 AP 相关的不良事件。
我们对 22 家儿童医院（2005 年 1 月至 2009 年 3 月）的 22 岁以下接受 40 种常见普外科和泌尿科手术之一的所有患者进行了 5 年回顾性分析。AP 的适应证由发表的专业特定指南定义。研究了艰难梭菌感染和药物过敏替代事件（苯海拉明和肾上腺素的使用），作为潜在的抗生素相关不良事件。
共确定了 246316 例手术，其中 25%符合 AP 标准。在需要 AP 的手术中，82%的儿童在手术期间接受了抗生素（范围：医院间 60%-96%），而在无适应证时，40%的儿童接受了抗生素（范围：医院间 10%-83%）。所有研究的手术中，接受 AP 的可能性在医院间存在显著差异（P<0.0001）。接受 AP 的儿童不良事件发生率显著高于未接受者（艰难梭菌：18.8[6.9-51.5]，P<0.0001；肾上腺素：1.8[1.7-2.0]，P<0.0001；苯海拉明：6.0[5.6-6.5]，P<0.0001）。
儿科手术人群中预防性使用抗生素的情况存在显著差异。许多需要使用抗生素的儿童未使用，甚至更多的儿童在无适应证时使用了抗生素。当将这些发现外推到所有接受手术的儿童时，从公共卫生的角度来看，这可能具有深远的意义。
