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Antibiotics
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Antimicrobial Use in Pediatrics
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Antimicrobial Use in Pediatrics

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (15 August 2022) | Viewed by 37468

Special Issue Editor

Dr. Daniele Donà

E-Mail Website
Guest Editor
Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35122 Padova, Italy
Interests: pediatric infectious disease; antibiotic stewardship; neonatal and pediatric infections; pharmacokinetics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antimicrobials are the most commonly prescribed medicine in paediatrics, but between 20 to 50% of these prescriptions have been demonstrated to be potentially unnecessary or inappropriate. Many children still receive broad-spectrum antibiotics for viral infections or antibiotic and antifungal courses that are significantly longer than needed. This unnecessary exposure increases the risk of severe side effects, raises healthcare costs, and contributes significantly to the global emergency of antimicrobial resistance.

The emergence of resistant pathogens and their global spread has rapidly become a significant threat to public health worldwide, with limited treatment options available for paediatric use, increasing the need to optimise the use of currently employed antimicrobials.  

One of the main aims of public health organisations is to promote antimicrobial stewardship across worldwide healthcare institutions, reducing inappropriate prescriptions and the associated adverse events and healthcare costs. 

On the other hand, there is a need to focus on the best dosing strategy for the already available antimicrobials to improve overall outcomes in children and neonates. Understanding pharmacokinetic/pharmacodynamic principles allows the selection of the ideal dosing regimen to eradicate the infection, reduce toxicity, and reduce the development of bacterial resistance.

This process is even more complex in neonates and children due to their age-related changes in physiological characteristics that impact the pharmacokinetic parameters of the administered drug, mainly due to variations in absorption, distribution, metabolism, and excretion. Moreover, further variations in the pharmacokinetics of predominantly hydrophilic antimicrobials occur in critically ill neonates and children.

This Special Issue proposes to explore how to improve the use of antimicrobials in paediatrics, encouraging papers on antimicrobial stewardship programs or strategies to optimise antimicrobial administration and dosing in clinical practice in children and neonates.

Dr. Daniele Donà
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Published Papers (10 papers)

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Research

11 pages, 2018 KiB  
Article
Cerebrospinal Fluid System Infection in Children with Cancer: A Retrospective Analysis over 14 Years in a Major European Pediatric Cancer Center
by Antonia Diederichs, Evelyn Pawlik, Anke Barnbrock, Stefan Schöning, Jürgen Konczalla, Tobias Finger, Thomas Lehrnbecher, Stephan Göttig and Konrad Bochennek
Antibiotics 2022, 11(8), 1113; https://doi.org/10.3390/antibiotics11081113 - 17 Aug 2022
Cited by 1 | Viewed by 2045
Abstract
Infection of a cerebrospinal fluid system is a serious medical complication. We performed a retrospective monocentric analysis on temporary and permanent cerebrospinal fluid devices in children with and without cancer, covering a period of over 14 years. Between 2004 and 2017, 275 children [...] Read more.
Infection of a cerebrospinal fluid system is a serious medical complication. We performed a retrospective monocentric analysis on temporary and permanent cerebrospinal fluid devices in children with and without cancer, covering a period of over 14 years. Between 2004 and 2017, 275 children with a cerebrospinal fluid system were seen at our institution. Thirty-eight children suffered from 51 microbiologically proven infectious episodes of the cerebrospinal fluid system (12 children with cancer and 26 children without cancer). Independently of the cerebrospinal fluid system used, the incidence of infection did not significantly differ between children with and without cancer and was the highest in children younger than one year. Infection occurred earlier in external ventricular drain (EVD) than ventriculoperitoneal (VP) shunt, and in EVD significantly earlier in children with cancer compared with patients without cancer. The pathogens isolated were mainly Gram-positive bacteria, in particular Staphylococcus spp., which should be taken into account for empirical antimicrobial therapy. Full article
(This article belongs to the Special Issue Antimicrobial Use in Pediatrics)
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17 pages, 326 KiB  
Article
Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study
by Susanna Esposito, Mino Zucchelli, Sonia Bianchini, Laura Nicoletti, Sara Monaco, Erika Rigotti, Laura Venditto, Cinzia Auriti, Caterina Caminiti, Elio Castagnola, Giorgio Conti, Maia De Luca, Daniele Donà, Luisa Galli, Silvia Garazzino, Stefania La Grutta, Laura Lancella, Mario Lima, Giuseppe Maglietta, Gloria Pelizzo, Nicola Petrosillo, Giorgio Piacentini, Simone Pizzi, Alessandro Simonini, Simonetta Tesoro, Elisabetta Venturini, Fabio Mosca, Annamaria Staiano, Nicola Principi and on behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Groupadd Show full author list remove Hide full author list
Antibiotics 2022, 11(7), 856; https://doi.org/10.3390/antibiotics11070856 - 26 Jun 2022
Cited by 2 | Viewed by 2982
Abstract
Pediatric neurosurgery is a highly specialized branch of surgery in which surgical site infections (SSIs) are potentially serious complications that can also adversely affect a good surgical outcome, compromising functional recovery and, in some cases, even putting the patient’s life at risk. The [...] Read more.
Pediatric neurosurgery is a highly specialized branch of surgery in which surgical site infections (SSIs) are potentially serious complications that can also adversely affect a good surgical outcome, compromising functional recovery and, in some cases, even putting the patient’s life at risk. The main aim of this consensus document is to provide clinicians with a series of recommendations on antimicrobial prophylaxis for neonates and children undergoing neurosurgery. The following scenarios were considered: (1) craniotomy or cranial/cranio-facial approach to craniosynostosis; (2) neurosurgery with a trans-nasal-trans-sphenoidal approach; (3) non-penetrating head injuries; (4) penetrating head fracture; (5) spinal surgery (extradural and intradural); (6) shunt surgery or neuroendoscopy; (7) neuroendovascular procedures. Patients undergoing neurosurgery often undergo peri-operative antibiotic prophylaxis, with different schedules, not always supported by scientific evidence. This consensus provides clear and shared indications, based on the most updated literature. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, and represents, in our opinion, the most complete and up-to-date collection of recommendations on the behavior to be held in the peri-operative setting in this type of intervention, in order to guide physicians in the management of the patient, standardize approaches and avoid abuse and misuse of antibiotics. Full article
(This article belongs to the Special Issue Antimicrobial Use in Pediatrics)
17 pages, 332 KiB  
Article
Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study
by Sonia Bianchini, Chiara Morini, Laura Nicoletti, Sara Monaco, Erika Rigotti, Caterina Caminiti, Giorgio Conti, Maia De Luca, Daniele Donà, Giuseppe Maglietta, Laura Lancella, Andrea Lo Vecchio, Giorgio Marchini, Carlo Pietrasanta, Nicola Principi, Alessandro Simonini, Elisabetta Venturini, Rosa Longo, Elena Gusson, Domenico Boccuzzi, Luca Vigo, Fabio Mosca, Annamaria Staiano, Susanna Esposito and on Behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Groupadd Show full author list remove Hide full author list
Antibiotics 2022, 11(5), 561; https://doi.org/10.3390/antibiotics11050561 - 22 Apr 2022
Cited by 3 | Viewed by 3445
Abstract
Ocular surgery encompasses a wide range of procedures, including surgery of the tear ducts, eyelid, cornea and conjunctiva, lens, ocular muscle, and vitreoretinal and iris surgery. Operations are also performed for the removal of tumors, repairs of ocular trauma and, finally, corneal transplantation. [...] Read more.
Ocular surgery encompasses a wide range of procedures, including surgery of the tear ducts, eyelid, cornea and conjunctiva, lens, ocular muscle, and vitreoretinal and iris surgery. Operations are also performed for the removal of tumors, repairs of ocular trauma and, finally, corneal transplantation. Antibiotic prophylaxis for the prevention of surgical site infections (SSIs) in ocular surgery is a complex field in which shared lines of action are absent. In light of the scarcity of shared evidence in the use of ocular antimicrobial prophylaxis for the pediatric population, this consensus document aims to provide clinicians with a series of recommendations on antimicrobial prophylaxis for patients of neonatal and pediatric age undergoing eye surgery. The following scenarios are considered: (1) intraocular surgery; (2) extraocular surgery; (3) ocular trauma; (4) ocular neoplasm; (5) ocular surface transplantations; (6) corneal grafts. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding clinical actions in the peri-operative environment in eye surgery. The application of uniform and shared protocols aims to improve surgical practice, through the standardization of procedures, with a consequent reduction of SSIs, also limiting the phenomenon of antimicrobial resistance. Full article
(This article belongs to the Special Issue Antimicrobial Use in Pediatrics)
23 pages, 404 KiB  
Article
Peri-Operative Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Cardiac and Thoracic Surgery: A RAND/UCLA Appropriateness Method Consensus Study
by Sonia Bianchini, Laura Nicoletti, Sara Monaco, Erika Rigotti, Agnese Corbelli, Annamaria Colombari, Cinzia Auriti, Caterina Caminiti, Giorgio Conti, Maia De Luca, Daniele Donà, Luisa Galli, Silvia Garazzino, Alessandro Inserra, Stefania La Grutta, Laura Lancella, Mario Lima, Andrea Lo Vecchio, Gloria Pelizzo, Nicola Petrosillo, Giorgio Piacentini, Carlo Pietrasanta, Nicola Principi, Matteo Puntoni, Alessandro Simonini, Simonetta Tesoro, Elisabetta Venturini, Annamaria Staiano, Fabio Caramelli, Gaetano Domenico Gargiulo, Susanna Esposito and on behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Groupadd Show full author list remove Hide full author list
Antibiotics 2022, 11(5), 554; https://doi.org/10.3390/antibiotics11050554 - 21 Apr 2022
Cited by 3 | Viewed by 3802
Abstract
Surgical site infections (SSIs) represent a potential complication of surgical procedures, with a significant impact on mortality, morbidity, and healthcare costs. Patients undergoing cardiac surgery and thoracic surgery are often considered patients at high risk of developing SSIs. This consensus document aims to [...] Read more.
Surgical site infections (SSIs) represent a potential complication of surgical procedures, with a significant impact on mortality, morbidity, and healthcare costs. Patients undergoing cardiac surgery and thoracic surgery are often considered patients at high risk of developing SSIs. This consensus document aims to provide information on the management of peri-operative antibiotic prophylaxis for the pediatric and neonatal population undergoing cardiac and non-cardiac thoracic surgery. The following scenarios were considered: (1) cardiac surgery for the correction of congenital heart disease and/or valve surgery; (2) cardiac catheterization without the placement of prosthetic material; (3) cardiac catheterization with the placement of prosthetic material; (4) implantable cardiac defibrillator or epicardial pacemaker placement; (5) patients undergoing ExtraCorporal Membrane Oxygenation; (6) cardiac tumors and heart transplantation; (7) non-cardiac thoracic surgery with thoracotomy; (8) non-cardiac thoracic surgery using video-assisted thoracoscopy; (9) elective chest drain placement in the pediatric patient; (10) elective chest drain placement in the newborn; (11) thoracic drain placement in the trauma setting. This consensus provides clear and shared indications, representing the most complete and up-to-date collection of practice recommendations in pediatric cardiac and thoracic surgery, in order to guide physicians in the management of the patient, standardizing approaches and avoiding the abuse and misuse of antibiotics. Full article
(This article belongs to the Special Issue Antimicrobial Use in Pediatrics)
17 pages, 688 KiB  
Article
Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness Method Consensus Study
by Susanna Esposito, Rossella Sgarzani, Sonia Bianchini, Sara Monaco, Laura Nicoletti, Erika Rigotti, Marilia Di Pietro, Roberta Opri, Caterina Caminiti, Matilde Ciccia, Giorgio Conti, Daniele Donà, Mario Giuffré, Stefania La Grutta, Laura Lancella, Mario Lima, Andrea Lo Vecchio, Gloria Pelizzo, Giorgio Piacentini, Carlo Pietrasanta, Matteo Puntoni, Alessandro Simonini, Elisabetta Venturini, Annamaria Staiano, Nicola Principi and on behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Groupadd Show full author list remove Hide full author list
Antibiotics 2022, 11(4), 506; https://doi.org/10.3390/antibiotics11040506 - 11 Apr 2022
Cited by 4 | Viewed by 3986
Abstract
For many years, it was clearly shown that surgical procedures might be associated with surgical site infection (SSI). Many scientific institutions prepared guidelines to use in surgery to reduce abuse and misuse of antibiotics. However, in the general guidelines for surgical antibiotic prophylaxis, [...] Read more.
For many years, it was clearly shown that surgical procedures might be associated with surgical site infection (SSI). Many scientific institutions prepared guidelines to use in surgery to reduce abuse and misuse of antibiotics. However, in the general guidelines for surgical antibiotic prophylaxis, plastic surgical procedures are not addressed or are only marginally discussed, and children were almost systematically excluded. The main aim of this Consensus document is to provide clinicians with recommendations on antimicrobial prophylaxis for pediatric patients undergoing plastic surgery. The following scenarios were considered: clean plastic surgery in elective procedures with an exclusive skin and subcutis involvement; clean-contaminated/contaminated plastic surgery in elective procedures with an exclusive skin and subcutis involvement; elective plastic surgery with use of local flaps; elective plastic surgery with the use of grafts; prolonged elective plastic surgery; acute burns; clean contused lacerated wounds without bone exposure; high-risk contused lacerated wounds or with bone exposure; contused lacerated wound involving the oral mucosa; plastic surgery following human bite; plastic surgery following animal bite; plastic surgery with tissue expander insertion. Our Consensus document shows that antimicrobial perioperative prophylaxis in pediatric patients undergoing plastic surgery is recommended in selected cases. While waiting the results of further pediatric studies, the application of uniform and shared protocols in these procedures will improve surgical practice, with a reduction in SSIs and consequent rationalization of resources and costs, as well as limiting the phenomenon of antimicrobial resistance. Full article
(This article belongs to the Special Issue Antimicrobial Use in Pediatrics)
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19 pages, 356 KiB  
Article
Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study
by Erika Rigotti, Sonia Bianchini, Laura Nicoletti, Sara Monaco, Elena Carrara, Francesca Opri, Roberta Opri, Caterina Caminiti, Daniele Donà, Mario Giuffré, Alessandro Inserra, Laura Lancella, Alessandro Mugelli, Giorgio Piacentini, Nicola Principi, Simonetta Tesoro, Elisabetta Venturini, Annamaria Staiano, Alberto Villani, Enrico Sesenna, Claudio Vicini, Susanna Esposito and on behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Groupadd Show full author list remove Hide full author list
Antibiotics 2022, 11(3), 382; https://doi.org/10.3390/antibiotics11030382 - 13 Mar 2022
Cited by 4 | Viewed by 4675
Abstract
Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the [...] Read more.
Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the first respiratory tracts are normally colonized by a bacterial flora. The aim of this consensus document was to provide clinicians with recommendations on surgical antimicrobial prophylaxis in neonates (<28 days of chronological age) and pediatric patients (within the age range of 29 days–18 years) undergoing dental, maxillo-facial or ENT surgical procedures. These included: (1) dental surgery; (2) maxilla-facial surgery following trauma with fracture; (3) temporo-mandibular surgery; (4) cleft palate and cleft lip repair; (5) ear surgery; (6) endoscopic paranasal cavity surgery and septoplasty; (7) clean head and neck surgery; (8) clean/contaminated head and neck surgery and (9) tonsillectomy and adenoidectomy. Due to the lack of pediatric data for the majority of dental, maxillo-facial and ENT surgeries and the fact that the recommendations for adults are currently used, there is a need for ad hoc studies to be rapidly planned for the most deficient areas. This seems even more urgent for interventions such as those involving the first airways since the different composition of the respiratory microbiota in children compared to adults implies the possibility that surgical antibiotic prophylaxis schemes that are ideal for adults may not be equally effective in children. Full article
(This article belongs to the Special Issue Antimicrobial Use in Pediatrics)
13 pages, 278 KiB  
Article
Antimicrobial Prophylaxis for Urologic Procedures in Paediatric Patients: A RAND/UCLA Appropriateness Method Consensus Study in Italy
by Susanna Esposito, Erika Rigotti, Alberto Argentiero, Caterina Caminiti, Elio Castagnola, Laura Lancella, Elisabetta Venturini, Maia De Luca, Stefania La Grutta, Mario Lima, Simonetta Tesoro, Matilde Ciccia, Annamaria Staiano, Giovanni Autore, Giorgio Piacentini, Nicola Principi and The Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Group
Antibiotics 2022, 11(3), 296; https://doi.org/10.3390/antibiotics11030296 - 23 Feb 2022
Cited by 5 | Viewed by 4542
Abstract
The main aim of surgical antimicrobial prophylaxis (SAP) in urologic procedures is to prevent bacteraemia, surgical site infections (SSIs), and postoperative urinary tract infections (ppUTIs). Guidelines for SAP in paediatric urology are lacking. Only some aspects of this complex topic have been studied, [...] Read more.
The main aim of surgical antimicrobial prophylaxis (SAP) in urologic procedures is to prevent bacteraemia, surgical site infections (SSIs), and postoperative urinary tract infections (ppUTIs). Guidelines for SAP in paediatric urology are lacking. Only some aspects of this complex topic have been studied, and the use of antibiotic prophylaxis prior to surgical procedures seems to be more often linked to institutional schools of thought or experts’ opinions than to rules dictated by studies demonstrating the most correct and preferred management. Therefore, the aim of this Consensus document realized using the RAND/UCLA appropriateness method is to provide clinicians with a series of recommendations on SAP for the prevention of bacteraemia, SSIs, and ppUTIs after urologic imaging and surgical procedures in paediatric patients. Despite the few available studies, experts agree on some basilar concepts related to SAP for urologic procedures in paediatric patients. Before any urological procedure is conducted, UTI must be excluded. Clean procedures do not require SAP, with the exception of prosthetic device implantation and groin and perineal incisions where the SSI risk may be increased. In contrast, SAP is needed in clean-contaminated procedures. Studies have also suggested the safety of eliminating SAP in paediatric hernia repair and orchiopexy. To limit the emergence of resistance, every effort to reduce and rationalize antibiotic consumption for SAP must be made. Increased use of antibiotic stewardship can be greatly effective in this regard. Full article
(This article belongs to the Special Issue Antimicrobial Use in Pediatrics)
15 pages, 337 KiB  
Article
Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Undergoing Orthopedic and Hand Surgery: A RAND/UCLA Appropriateness Method Consensus Study
by Francesca Opri, Sonia Bianchini, Laura Nicoletti, Sara Monaco, Roberta Opri, Marilia Di Pietro, Elena Carrara, Erika Rigotti, Cinzia Auriti, Caterina Caminiti, Daniele Donà, Laura Lancella, Andrea Lo Vecchio, Simone Pizzi, Nicola Principi, Alessandro Simonini, Simonetta Tesoro, Eisabetta Venturini, Alberto Villani, Annamaria Staiano, Leonardo Marchesini Reggiani, Susanna Esposito and on behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Groupadd Show full author list remove Hide full author list
Antibiotics 2022, 11(3), 289; https://doi.org/10.3390/antibiotics11030289 - 22 Feb 2022
Cited by 4 | Viewed by 3030
Abstract
Surgical site infections (SSIs) represent a potential complication in any type of surgery and can occur up to one year after the procedure in the case of implant placement. In the field of orthopedic and hand surgery, the rate of SSIs is a [...] Read more.
Surgical site infections (SSIs) represent a potential complication in any type of surgery and can occur up to one year after the procedure in the case of implant placement. In the field of orthopedic and hand surgery, the rate of SSIs is a relevant issue, considering the need for the placement of synthesis devices and the type of some interventions (e.g., exposed fractures). This work aims to provide guidance on the management of peri-operative antibiotic prophylaxis for the pediatric and neonatal population undergoing orthopedic and hand surgery in order to standardize the management of patients and to reduce, on the one hand, the risk of SSI and, on the other, the development of antimicrobial resistance. The following scenarios were considered: (1) bloodless fracture reduction; (2) reduction of unexposed fracture and grade I and II exposed fracture; (3) reduction of grade III exposed fracture or traumatic amputation; (4) cruel fracture reduction with percutaneous synthesis; (5) non-traumatic amputation; (6) emergency intact skin trauma surgery and elective surgery without synthetic media placement; (7) elective orthopedic surgery with prosthetic and/or synthetic media placement and spinal surgery; (8) clean elective hand surgery with and without bone involvement, without use of synthetic means; (9) surgery of the hand on an elective basis with bone involvement and/or with use of synthetic means. This manuscript has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding the behavior to be adopted in the peri-operative setting in neonatal and pediatric orthopedic and hand surgery. The specific scenarios developed are aimed at guiding the healthcare professional in practice to ensure the better and standardized management of neonatal and pediatric patients, together with an easy consultation. Full article
(This article belongs to the Special Issue Antimicrobial Use in Pediatrics)
23 pages, 402 KiB  
Article
Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study
by Sonia Bianchini, Erika Rigotti, Sara Monaco, Laura Nicoletti, Cinzia Auriti, Elio Castagnola, Giorgio Conti, Luisa Galli, Mario Giuffrè, Stefania La Grutta, Laura Lancella, Andrea Lo Vecchio, Giuseppe Maglietta, Nicola Petrosillo, Carlo Pietrasanta, Nicola Principi, Simonetta Tesoro, Elisabetta Venturini, Giorgio Piacentini, Mario Lima, Annamaria Staiano, Susanna Esposito and the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Groupadd Show full author list remove Hide full author list
Antibiotics 2022, 11(2), 279; https://doi.org/10.3390/antibiotics11020279 - 21 Feb 2022
Cited by 5 | Viewed by 4613
Abstract
Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible [...] Read more.
Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible since about 50% of SSIs occur after the hospital discharge. Gastrointestinal surgical procedures are among the surgical procedures with the highest risk of SSIs, especially when colon surgery is considered. Data that were collected from children seem to indicate that the risk of SSIs can be higher than in adults. This consensus document describes the use of preoperative antibiotic prophylaxis in neonates and children that are undergoing abdominal surgery and has the purpose of providing guidance to healthcare professionals who take care of children to avoid unnecessary and dangerous use of antibiotics in these patients. The following surgical procedures were analyzed: (1) gastrointestinal endoscopy; (2) abdominal surgery with a laparoscopic or laparotomy approach; (3) small bowel surgery; (4) appendectomy; (5) abdominal wall defect correction interventions; (6) ileo-colic perforation; (7) colorectal procedures; (8) biliary tract procedures; and (9) surgery on the liver or pancreas. Thanks to the multidisciplinary contribution of experts belonging to the most important Italian scientific societies that take care of neonates and children, this document presents an invaluable reference tool for perioperative antibiotic prophylaxis in the paediatric and neonatal populations. Full article
(This article belongs to the Special Issue Antimicrobial Use in Pediatrics)
17 pages, 296 KiB  
Article
Surgical Antimicrobial Prophylaxis in Neonates and Children with Special High-Risk Conditions: A RAND/UCLA Appropriateness Method Consensus Study
by Sonia Bianchini, Erika Rigotti, Laura Nicoletti, Sara Monaco, Cinzia Auriti, Elio Castagnola, Guido Castelli Gattinara, Maia De Luca, Luisa Galli, Silvia Garazzino, Stefania La Grutta, Laura Lancella, Andrea Lo Vecchio, Giuseppe Maglietta, Carlotta Montagnani, Nicola Petrosillo, Carlo Pietrasanta, Nicola Principi, Alessandra Simonini, Simonetta Tesoro, Elisabetta Venturini, Giorgio Piacentini, Mario Lima, Annamaria Staiano, Susanna Esposito and on behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Groupadd Show full author list remove Hide full author list
Antibiotics 2022, 11(2), 246; https://doi.org/10.3390/antibiotics11020246 - 14 Feb 2022
Cited by 10 | Viewed by 3460
Abstract
Surgical site infections (SSIs), which are a potential complications in surgical procedures, are associated with prolonged hospital stays and increased postoperative mortality rates, and they also have a significant economic impact on health systems. Data in literature regarding risk factors for SSIs in [...] Read more.
Surgical site infections (SSIs), which are a potential complications in surgical procedures, are associated with prolonged hospital stays and increased postoperative mortality rates, and they also have a significant economic impact on health systems. Data in literature regarding risk factors for SSIs in pediatric age are scarce, with consequent difficulties in the management of SSI prophylaxis and with antibiotic prescribing attitudes in the various surgical procedures that often tend to follow individual opinions. The lack of pediatric studies is even more evident when we consider surgeries performed in subjects with underlying conditions that may pose an increased risk of complications. In order to respond to this shortcoming, we developed a consensus document to define optimal surgical antimicrobial prophylaxis (SAP) in neonates and children with specific high-risk conditions. These included the following: (1) colonization by methicillin-resistant Staphylococcus aureus (MRSA) and by multidrug resistant (MDR) bacteria other than MRSA; (2) allergy to first-line antibiotics; (3) immunosuppression; (4) splenectomy; (5) comorbidity; (6) ongoing antibiotic therapy or prophylaxis; (7) coexisting infection at another site; (8) previous surgery in the last month; and (9) presurgery hospitalization lasting more than 2 weeks. This work, made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, represents, in our opinion, the most up-to-date and comprehensive collection of recommendations relating to behaviors to be undertaken in a perioperative site in the presence of specific categories of patients at high-risk of complications during surgery. The application of uniform and shared protocols in these high-risk categories will improve surgical practice with a reduction in SSIs and consequent rationalization of resources and costs, as well as being able to limit the phenomenon of antimicrobial resistance. Full article
(This article belongs to the Special Issue Antimicrobial Use in Pediatrics)
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