Khabyeh-Hasbani Nathan, Yan Yufan, Rubinov Yossef, Bareket Elliot, Koehler Seven M
Division of Hand Surgery, Department of Orthopaedic Surgery, Montefiore Einstein, USA.
Department of Plastic and Reconstructive Surgery, Montefiore Einstein, USA.
Injury. 2025 Apr;56(4):112271. doi: 10.1016/j.injury.2025.112271. Epub 2025 Mar 17.
The literature has recently questioned the routine use of prophylactic antibiotics in adults undergoing clean, upper extremities surgeries. Moreover, consensus remains elusive if antibiotic prophylaxis in upper extremity (UE) and hand pediatric procedures are necessary. Therefore, we aim to investigate whether antibiotic prophylaxis has no effect on reducing postoperative surgical site infection (SSI) rates in pediatric upper extremity (UE) procedures.
A retrospective review of all pediatric patients undergoing clean UE surgery between November 2021 and November 2023 at a single institution was performed. Primary outcome measures were diagnosis of SSI by 14-days and 30-days. Secondary outcomes included the type of management employed to treat infection, including the use of antibiotics only, operative washout and hardware removal. Chi-square and Fisher's exact tests were performed for categorical variables, and Wilcoxon rank-sum tests were performed for continuous variables. A p-value of < 0.05 for all analyses was considered statistically significant.
396 patients (150 female and 246 male) were included for analysis- 217 received preoperative antibiotics and 179 did not. Among those who received preoperative antibiotics, only two patients were diagnosed with an SSI, with an infection rate of 0.9 %. Similarly, in those who did not receive preoperative antibiotics, two patients were diagnosed with an SSI, with an infection rate of 1.1 %. Infection rates were not statistically different (p = 0.846). The odds ratio (OR) of having an SSI when not receiving preoperative antibiotics is 1.21 (95 % CI: 0.16 - 8.71).
The study challenges the historical dogma of the necessity of preoperative antibiotics in pediatric upper extremity surgeries. The findings suggest that there is no statistical difference in postoperative SSI rates whether antibiotic prophylaxis is administered. To reassess the necessity of preoperative antibiotics in upper extremity cases, further randomized controlled studies with larger patient populations should be advocated for.
近期文献对清洁上肢手术的成年患者常规使用预防性抗生素提出了质疑。此外，对于上肢（UE）和手部儿科手术是否有必要进行抗生素预防，目前仍未达成共识。因此，我们旨在研究抗生素预防对降低儿科上肢（UE）手术术后手术部位感染（SSI）率是否无效。
对2021年11月至2023年11月在单一机构接受清洁UE手术的所有儿科患者进行回顾性研究。主要结局指标为术后14天和30天的SSI诊断。次要结局包括治疗感染所采用的管理类型，包括仅使用抗生素、手术冲洗和取出内固定物。对分类变量进行卡方检验和Fisher精确检验，对连续变量进行Wilcoxon秩和检验。所有分析的p值<0.05被认为具有统计学意义。
纳入396例患者（150例女性和246例男性）进行分析，其中217例接受了术前抗生素治疗，179例未接受。在接受术前抗生素治疗的患者中，仅有2例被诊断为SSI，感染率为0.9%。同样，在未接受术前抗生素治疗的患者中，有2例被诊断为SSI，感染率为1.1%。感染率无统计学差异（p = 0.846）。未接受术前抗生素治疗时发生SSI的比值比（OR）为1.21（95%CI：0.16 - 8.71）。
该研究对儿科上肢手术术前抗生素必要性的传统观念提出了挑战。研究结果表明，无论是否进行抗生素预防，术后SSI率均无统计学差异。为重新评估上肢手术术前抗生素的必要性，应提倡开展更大样本量的进一步随机对照研究。
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