Perioperative Antibiotic Prophylaxis in Open Hand Injuries in Children

Relevance. The rapid development of new technologies in surgery has opened up broad horizons for the implementation of complex surgical interventions. At the same time, the duration of operations was reduced, the invasiveness decreased, and broad operational approaches began to go into the past. However, the infectious process in the area of operative action remains an acute problem of surgery today. Infections of the surgical area (OSIW) are infections that develop within 30 days after surgery or within a year after installing the prosthesis (heart valves, blood vessels or joint).Aim. Develop an algorithm for perioperative antibiotic prophylaxis for open tubular fractures based on experimental research.Methods. An experimental study was conducted on 60 adult guinea pigs, which created a model of an open femur fracture. All animals were divided into 3 groups depending on the timing of the introduction of antibacterial drugs. The degree of local manifestations was assessed according to the developed scale from 0 to 2 points, where 0 is the total absence of inflammatory manifestations, and 2 points is their maximum manifestation. The signs of inflammation were also evaluated in the general clinical blood test.Results. During the experiment it was revealed that the introduction of antibacterial drugs for open fractures of tubular bones is necessary for prophylactic purposes. An increase in the timing of the introduction of antibiotics to three days or more is not rational, since there are no significant differences compared with a shorter course of antibiotic prophylaxis. Conclusions. Experimental perioperative antibiotic prophylaxis (PAP) on the model of an open fracture of the tubular bone indicated the possibility of introducing the PAP algorithm for open hand injuries in children.

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Rational perioperative antibiotic prophylaxis for open damages of brush in children

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic698 ◽

2020 ◽

Vol 10 (4) ◽

pp. 419-428

Author(s):

Ivan I. Gordienko ◽

Natalya A. Tsap

Keyword(s):

Antibiotic Prophylaxis ◽

Complete Blood Count ◽

Clinical Signs ◽

Clinical Results ◽

Blood Analysis ◽

Hand Injuries ◽

Tubular Bone ◽

Short Term ◽

Perioperative Antibiotic Prophylaxis ◽

Rational Algorithm

Introduction. Today, hand injuries are one of the most pressing and common problems in modern traumatology worldwide. Results obtained statistically indicate a fairly high frequency of hand injuries, including open ones. Often, an incorrect prescription of antibiotics in the form of unjustified antibiotic therapy in the absence of direct indications is done. Aim. This study aimed to develop a rational algorithm for perioperative antibiotic prophylaxis for open hand injuries in children based on experimental and clinical research. Materials and methods. The study was divided into two phases: experimental and clinical. The experiment was carried out on 60 sexually mature, outbred guinea pigs. During the experiment, the analysis of clinical signs of inflammation, complete blood count and biochemical blood analysis, spiral computed tomography, and morphological study of the consolidation zone were performed. The clinical part of the work is based on the analysis of surgical treatment results of 120 children with open hand injuries, which were divided into two groups: the main group that included 50 children receiving treatment according to the experimentally developed perioperative antibiotic prophylaxis (PAP) algorithm, and the comparison group included 70 children receiving a perioperative course of antibiotics from 0 to 7 days, without a well-defined algorithm. Results. In the analysis of clinical results, laboratory, radiation, and morphological methods of studying the experimental material, the absence of antibiotic prophylaxis in open fractures of small tubular bones with a 90% probability was found to entail pro-inflammatory complications in the area of postoperative wound; however, a one day short-term course of PAP will prevent complications and will not have statistically significant differences with a longer course of three days. Discussion. Results of a clinical study proved the effectiveness of the developed algorithm and showed better results in early and late postoperative period in comparison with the chaotic prescription of antibacterial drugs without a clear algorithm; however, no statistically significant differences in the level of postoperative complications were found. Conclusion. On the basis of an experimental model of an open fracture of the tubular bone, osteosynthesis and various courses of antibiotic prophylaxis has proven that a short-term course of PAP within 24 h is the most optimal one, and achieving minimal risks of inflammatory complications and better anatomical and functional outcomes in clinical practice.

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