Rottgers S Alex, Camison Liliana, Mai Rick, Shakir Sameer, Grunwaldt Lorelei, Nowalk Andrew J, Natali Megan, Losee Joseph E
St. Petersburg, Fla.; Baltimore, Md.; and Pittsburgh, Pa. From the Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical School; the Divisions of Pediatric Plastic Surgery and Pediatric Infectious Diseases, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center; and the Department of Surgery, Allegheny General Hospital.
Plast Reconstr Surg. 2016 Feb;137(2):574-582. doi: 10.1097/01.prs.0000475784.29575.d6.
The literature provides no guidelines for antibiotic use in palatoplasty. The authors sought to ascertain practice patterns; review a large, single-surgeon experience, and propose guidelines for antibiotic use in primary palatoplasty.
A six-question survey was e-mailed to all surgeons of the American Cleft Palate-Craniofacial Association. A retrospective study was also conducted of the senior author's 10-year primary palatoplasty series, and two groups were studied. Group 1 received no antibiotics. Group 2 received preoperative and/or postoperative antibiotics.
Three hundred twelve of 1115 surgeons (28 percent) responded to the survey. Eighty-five percent administered prophylactic antibiotics, including 26 percent who used a single preoperative dose. A further 23 percent gave 24 hours of postoperative therapy; 12 percent used 25 to 72 hours, 16 percent used 4 to 5 days, and 12 percent used 6 to 10 days. Five percent of surgeons administered penicillin, 64 percent administered a first-generation cephalosporin, 13 percent administered ampicillin/sulbactam, and 8 percent gave clindamycin. The authors reviewed 311 patients; 173 receive antibiotics and 138 did not. Delayed healing and fistula rates did not differ between groups: 16.8 percent versus 15.2 percent (p = 0.71) and 2.9 percent versus 1.4 percent (p = 0.47), respectively. A single patient treated without antibiotics developed a postoperative bacteremia. This case did not meet the Centers for Disease Control definition of a surgical site infection, but the patient developed a palatal fistula.
Antibiotic use in primary palatoplasty varies widely. The authors' data support a clinician's choice to forego antibiotic use; however, given the significance of palatal fistulae and the single case of postoperative streptococcal bacteremia, the study group recommends a single preoperative dose of ampicillin/sulbactam. Current evidence cannot justify the use of protracted antibiotic regimens.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
文献中没有关于腭裂修复术中抗生素使用的指南。作者试图确定实际应用模式；回顾一位资深外科医生的大量单中心经验，并提出一期腭裂修复术中抗生素使用的指南。
向美国腭裂-颅面协会的所有外科医生发送了一份包含六个问题的调查问卷。还对资深作者的10年一期腭裂修复病例系列进行了回顾性研究，并将患者分为两组。第1组未使用抗生素。第2组接受术前和/或术后抗生素治疗。
1115名外科医生中有312名（28%）回复了调查问卷。85%的医生使用预防性抗生素，其中26%的医生术前仅使用一剂。另有23%的医生术后使用24小时抗生素治疗；12%的医生使用25至72小时，16%的医生使用4至5天，12%的医生使用6至10天。5%的医生使用青霉素，64%的医生使用第一代头孢菌素，13%的医生使用氨苄西林/舒巴坦，8%的医生使用克林霉素。作者回顾了311例患者；173例接受了抗生素治疗，138例未接受。两组之间的愈合延迟和瘘管发生率没有差异：分别为16.8%对15.2%（p = 0.71）和2.9%对1.4%（p = 0.47）。一名未使用抗生素治疗的患者发生了术后菌血症。该病例不符合疾病控制中心手术部位感染的定义，但该患者出现了腭瘘。
一期腭裂修复术中抗生素的使用差异很大。作者的数据支持临床医生选择不使用抗生素；然而，鉴于腭瘘的重要性以及术后链球菌菌血症的单一病例，研究组建议术前单次使用氨苄西林/舒巴坦。目前的证据无法证明长期使用抗生素方案的合理性。
临床问题/证据级别：治疗性，III级。
