Vaze Dhananjay, Samujh Ram, Narasimha Rao Katragadda Lakshmi
Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Afr J Paediatr Surg. 2014 Apr-Jun;11(2):158-61. doi: 10.4103/0189-6725.132816.
Different studies underline the use of pre-operative antibiotic prophylaxis in clean surgeries like herniotomy and inguinal orchiopexy. But, the meta-analyses do not recommend nor discard the use of prophylactic pre-operative antibiotics. The scarcity of controlled clinical trials in paediatric population further vitiates the matter. This study assessed the difference in the rate of early post-operative wound infection cases in children who received single dose of pre-operative antibiotics and children who did not receive antibiotics after inguinal herniotomy and orchiopexy.
This randomised prospective study was conducted in Paediatric Surgery department of PGIMER Chandigarh. Out of 251 patients, 112 patients were randomised to the case group and 139 were ascribed to the control group. The patients in control group were given a standard regimen of single dose of intravenous antibiotic at the time of induction followed by 3-4 days of oral antibiotic. Case group patients underwent the surgical procedure in similar manner with no antibiotic either at the time of induction or post-operatively.
The incidence of surgical site infection in case group was 3.73 % and that in control group was 2.22%. The observed difference in the incidence of surgical site infection was statistically insignificant (P value = 0.7027). The overall infection rate in case and control group was 2.89%.
Our preliminary experience suggests that there is no statistically significant difference in the proportion of early post-operative wound infection between the patients who received single dose of pre-operative antibiotics and the patients who received no antibiotics after inguinal herniotomy and orchiopexy. The risk of surgical site infection in paediatric heriotomies does not increase even if the child's weight is less than his/her expected weight for age.
不同研究强调在疝修补术和腹股沟睾丸固定术等清洁手术中使用术前抗生素预防。但是，荟萃分析既不推荐也不摒弃使用预防性术前抗生素。儿科人群中对照临床试验的匮乏进一步使这一问题复杂化。本研究评估了在腹股沟疝修补术和睾丸固定术后接受单剂量术前抗生素的儿童与未接受抗生素的儿童术后早期伤口感染率的差异。
这项随机前瞻性研究在昌迪加尔PGIMER儿科外科进行。在251例患者中，112例患者被随机分配到病例组，139例被归入对照组。对照组患者在诱导时给予单剂量静脉抗生素标准方案，随后口服抗生素3 - 4天。病例组患者以类似方式进行手术，诱导时或术后均不使用抗生素。
病例组手术部位感染发生率为3.73%，对照组为2.22%。观察到的手术部位感染发生率差异无统计学意义（P值 = 0.7027）。病例组和对照组的总体感染率为2.89%。
我们的初步经验表明，在腹股沟疝修补术和睾丸固定术后，接受单剂量术前抗生素的患者与未接受抗生素的患者术后早期伤口感染比例无统计学显著差异。即使儿童体重低于其年龄预期体重，小儿疝修补术中手术部位感染的风险也不会增加。
