title: Influence of body mass index and antibiotic dose on the risk of surgical site infections in pediatric clean orthopedic surgery.
abstract: OBJECTIVE
  To evaluate body mass index (BMI) and antimicrobial dose as risk factors for surgical site infections in pediatric patients.
  
  
  METHODS
  Children between 2 and 19 years of age undergoing clean orthopedic procedures and receiving at least one dose of perioperative antibiotics (cefazolin, vancomycin, or clindamycin) were studied. The retrospective case-controlled study was conducted at the Alfred I. duPont Hospital for Children, a 180-bed tertiary-care academic pediatric hospital in Wilmington, DE. Data were collected from January 1, 2002, to December 31, 2005.
  
  
  RESULTS
  Underweight children had a higher risk for SSIs than overweight and normal-weight children. American Society of Anesthesiologists classes II and greater were associated with a greater risk of SSI. Longer procedures were also associated with a higher risk of SSI, specifically, duration of surgery >2 h. Children weighing ≥70 kg who received a standard dose of cefazolin (maximum of 1 g) had a higher risk of SSI caused by methicillin-sensitive Staphylococcus aureus (MSSA).
  
  
  CONCLUSIONS
  Being underweight and undergoing an operation lasting >2 h created significant risks for SSI. Children weighing ≥70 kg receiving a standard 1-g dose of cefazolin had a greater risk of MSSA SSIs than children weighing <70 kg who received an appropriate weight-based dose of this antibiotic.
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Cies
authors.forename: Shannon
authors.initials: S
authors.lastname: Chan
authors.forename: Jobayer
authors.initials: J
authors.lastname: Hossain
authors.forename: B Randall
authors.initials: BR
authors.lastname: Brenn
authors.forename: M Cecilia
authors.initials: MC
authors.lastname: Di Pentima
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D015992:Body Mass Index; D016022:Case-Control Studies; D002437:Cefazolin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage; D003691:Delaware; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D019990:Perioperative Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D014640:Vancomycin; D002437:Cefazolin