Giving children preventive antibiotics within one hour
before they undergo spinal surgery
greatly reduces the risk for serious infections after the
surgery, suggests a Johns Hopkins study
published in the August issue of Pediatric Infectious
Disease Journal (also available online ahead of
print).
Children who received antibiotics outside of the
golden one-hour window were three and a half
times more likely to develop serious infections at the
surgery site, researchers report, pointing out
that something as simple as ensuring that a child gets
timely prophylaxis can prevent serious
complications and reduce the length of hospital stay.
"When it comes to preventing infections, when a child
gets antibiotics appears to be one of the
most critical yet most easily modifiable risk factors, and
may matter just as much as the type and
dosage of the medication," said lead researcher Aaron
Milstone, infectious disease specialist at the
Johns Hopkins Children's Center. "The moral of this is
that an ounce of timely prevention is indeed
worth a pound of treatment."
Nearly 780,000 postsurgical infections occur in the
United States each year, according to
estimates from the Institute for Healthcare Improvement. An
infection after surgery nearly doubles
a patient's risk of death, doubles a patient's hospital
stay and adds up to $50,000 to treatment costs
per patient, researchers say.
While preoperative antibiotic prophylaxis is standard
in adults, there are no standard guidelines
on how to administer antibiotics in children undergoing
surgery.
Reviewing nearly 1,000 spinal fusion surgeries
performed in children over a six-year period at
Johns Hopkins, investigators found 36 deep surgical site
infections. More serious than superficial skin
infections, these can cause serious complications and
require aggressive treatment including additional
surgeries and long-term antibiotics. Of the 36 cases, 28
percent received medication outside the one-
hour window, either more than an hour before incision or
after the surgery began. Other factors
affecting infection risk included underlying medical
conditions and previous spinal surgeries,
researchers found.
Even though spinal fusion surgeries are complex
procedures and thus carry higher risk for
deep-site infections, the findings are likely relevant to
many types of surgical procedures, the
researchers say, because timing is always critical when
administering antibiotics, either as treatment
or prevention.
Other Johns Hopkins investigators in the study are
Lisa Maragakis, Timothy Townsend,
Kathleen Speck, Paul Sponseller, Xiaoyan Song and Trish
Perl. The research was funded by grants
from the Centers for Disease Control and the Pediatric
Infectious Diseases Society.
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