1 Department of Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland.
2 Department of Clinical Microbiology and Immunology, Children's Memorial Health Institute, Warsaw, Poland.
Surg Infect (Larchmt). 2019 May/Jun;20(4):253-260. doi: 10.1089/sur.2018.272. Epub 2019 Feb 14.
Prophylactic antibiotic therapy is given routinely in the peri-operative period to prevent surgical site infection. However, in pediatric cardiac surgery, an optimal schedule has not been defined. Pediatric recommendations follow the guidelines for adults, which might be improper because of the inherent challenges in pediatric research and the heterogeneity of the population. Implementation of an effective prophylaxis protocol is needed for children undergoing cardiac surgery, especially in view of worldwide antibiotic overuse and the development of drug resistance. In this review, we analyze the current knowledge supported by up-to-date publications about antibiotic prophylaxis in pediatric cardiac surgery. The PubMed database was searched for full-text journal articles describing peri-operative antibiotic prophylaxis in pediatric cardiac surgery published since 2000. Antibiotics used for standard prophylaxis with dosing schema, time of the first dose, additional dosage in extracorporeal circulation (ECC) priming, and prophylaxis duration were analyzed. Additionally, we looked for special clinical situations such as antibiotic prophylaxis in children with the sternum left open after surgery and patients with β-lactam allergy or pre-operative methicillin-resistant (MRSA) colonization or those requiring extracorporeal membrane oxygenation (ECMO). A total of 1,546 articles were evaluated, and we identified 20 for further analysis. On the basis of the current peri-operative antibiotic prophylaxis recommendations for cardiac surgery and the papers reviewed, we tried to propose a schedule for peri-operative antibiotic prophylaxis in pediatric cardiac surgery. There is a need for careful use and examination of the schedule proposed because the pharmacokinetics of antibiotics in pediatric patients with ECC is not fully understood. This should be evaluated further. Formulating uniform recommendations concerning peri-operative antibiotic prophylaxis is difficult.
预防性抗生素治疗在围手术期常规使用，以预防手术部位感染。然而，在儿科心脏手术中，尚未确定最佳方案。儿科建议遵循成人指南，但由于儿科研究固有的挑战和人群的异质性，这可能是不恰当的。需要为接受心脏手术的儿童实施有效的预防方案，特别是考虑到全球范围内抗生素的过度使用和耐药性的发展。在这篇综述中，我们分析了现有知识，这些知识是基于 2000 年以来发表的关于儿科心脏手术中抗生素预防的最新出版物。分析了用于标准预防的抗生素、剂量方案、第一剂的时间、体外循环（ECC）预充中的额外剂量以及预防持续时间。此外，我们还研究了特殊临床情况，如手术后胸骨未闭合的儿童、β-内酰胺过敏或术前耐甲氧西林金黄色葡萄球菌（MRSA）定植或需要体外膜氧合（ECMO）的患者的抗生素预防。共评估了 1546 篇文章，我们确定了 20 篇进一步分析。基于目前心脏手术围手术期抗生素预防建议和回顾的论文，我们尝试提出儿科心脏手术围手术期抗生素预防方案。由于不完全了解 ECC 中儿科患者的抗生素药代动力学，因此需要仔细使用和检查所提出的方案。这应该进一步评估。制定关于围手术期抗生素预防的统一建议是困难的。
