Give antibiotics within hour before first incision to avert postsurgical infections in kids

Administering preventive antibiotics to children within one hour before they undergo spinal surgery greatly reduces the risk for serious infections after the surgery, according to a study to be published in the August issue of the Pediatric Infectious Disease Journal.

Children who received antibiotics outside of the golden 1-hour window were three and half times more likely to develop serious infections at the surgery site, researchers reported in a press release.

They said the findings underscore the important message 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, [the time in which] 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 investigator Aaron Milstone, MD, infectious disease specialist at Johns Hopkins Children's Center in Baltimore. "The moral of this is that an ounce of timely prevention is indeed worth a pound of treatment."

Reviewing nearly 1,000 spinal fusion surgeries performed in children over a 6-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% received medication outside the 1-hour window, including either more than 1 hour before incision or after the surgery began. Other factors affecting infection risk included underlying medical conditions and previous spinal surgeries, according to the press release.

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 because timing is always critical when administering antibiotics, either as treatment or prevention, Milstone said in the press release.

Nearly 780,000 postsurgical infections occur in the United States each year, according to estimates from the Institute for Healthcare Improvement. But while preoperative antibiotic prophylaxis is standard in adults, there are no standard guidelines on how or when to administer antibiotics in children undergoing surgery, according to the press release.