Neonatal Surgery Antimicrobial Prophylaxis
|Publication: 01/06/2010 --|
|Last review: 29/01/2019|
|Next review: 03/01/2022|
|Approved By: Improving Antimicrobial Prescribing Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2019|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
Guideline for Antimicrobial Prophylaxis in Neonatal Surgery
Neonatal Surgery Antimicrobial Prophylaxis
Summary table of routine recommendations
It is the responsibility of the surgical team to prescribe the prophylactic antibiotics and to ensure that they have been given within one hour before incision.
*MRSA risk = previous or current MRSA infection or colonisation
Please Discuss with Microbiology for individual cases if any risk factors for or previous colonisation with antimicrobial resistant organisms
Perioperative prophylaxis for prevention of postoperative infections has been one of the major indications of antimicrobials infections in neonates and children. Two studies have demonstrated that approximately 75% of antimicrobial use in paediatric surgical services is for prophylaxis.
Prophylactic antibiotics have been shown to be effective in reducing post-operative infections in clean- contaminated and contaminated procedures whereas their efficacy remains controversial for clean surgical procedures. Studies documenting that systemic antimicrobial prophylaxis decrease the incidence of surgical site infections have been primarily performed in adults. As the pathogenesis of wound infections does not differ in any age groups, the guidelines have been extended for neonatal and paediatric use with recommendations for short duration of prophylaxis up to 24hours.
Prophylaxis is recommended for most gastrointestinal procedures. The number of organisms and proportion of anaerobic organisms progressively increase along the gastrointestinal tract, so the recommendation depends on the segment of gastrointestinal tract entered during the procedure. Colorectal procedures have a very high intrinsic risk of infection and warrant a strong recommendation for prophylaxis with antibiotics directed at gram negative bacteria and anaerobic organisms.
A small number of clinical trials support the use of perioperative antibiotics in non-cardiac thoracic surgery in adults with a decrease in surgical site infection post- operatively, however, there is no consistent data to demonstrate an effect of peri-operative antibiotics on the rate of postoperative pneumonia or empyema.
A single dose of prophylactic antibiotics which provides adequate tissue concentration throughout the procedure has been recommended for adults. Studies have shown that the administration of prophylactic antibiotics after wound closure does not reduce infection rates further and can result in harm. This may need to be reviewed in some vulnerable neonates, especially following closure of anterior abdominal wall; however duration of prophylaxis should not exceed 48hours and may need Discussion with Microbiology.
Antimicrobial prophylaxis in neonates
|Target patient group:||All neonates undergoing surgical procedures|
|Target professional group(s):||Secondary Care Doctors
Secondary Care Nurses
- SIGN. Antibiotic Prophylaxis in Surgery. Scottish Intercollegiate Guideline Network Publication Number 104. Edinburgh; 2008
- Fonseca SNS, Melon SR, Junqueira MJ, et al. Implementing 1-dose antibiotic prophylaxis for prevention of surgical site infection. Arch Surg 2006;141:1109-13
- BNFc December 2015 update accessed via www.medicinescomplete.com
Evidence level (A,B,C, D)
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. LTHT Consensus (no national guidelines exist, guidelines from different learned bodies contradict each other, or no evidence exists)
Improving Antimicrobial Prescribing Group
LHP version 1.0
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