title: Postoperative wound infection and perioperative prophylactic versus therapeutic antibiotics in paediatric abdominal surgeries: a five-year review.
abstract: BACKGROUND
  Outcome of a most successful surgical procedure may be affected by infective complications. This is a report of postoperative wound infection and outcome of perioperative antibiotics used in children with surgical abdomen.
  
  
  METHODS
  Postoperative wound infection and perioperative antibiotics used in children who had abdominal surgeries at two referral paediatric surgical centres between June 2004 and May 2009 were analyzed in a retrospective study.
  
  
  RESULTS
  All 1298 childrenaged between one month and 16 years with a male: female ratio 1.5:1 managed with surgical abdomen who presented after an average of 48 hours of symptoms had antibiotics; 458 (35.3%) prophylactic versus 840 (64.7%) therapeutic.Antimicrobials in penicillin, aminogycoside, quinolone, cephalosporingroups, and metronidazole were used either as single or combined agents in 458 (35.3%) children with clean-contaminated, 459 (35.4%) contaminated and 381 (29.3%) dirty wounds. Emergency operations performed on 791 (60.9%) children resulted in 157 (19.8%) postoperative wound infection compared to 507 (39.1%) operated on elective bases with 30 (5.9%) (P<0.0001). The wounds were superficial 71 (38%), deep 47 (25.15%) and intraperitoneal 39 (20.9%) in emergency cases, and 21 (1.6%) deaths occurred overall. Postoperative wound infection recorded in 16.7% (140/840) was higher in children who had therapeutic than in 10.3% (47/458) who received prophylactic antibiotics (P=0.0022). It was lower, 25% (38/152), using single agents for prophylaxis than therapy 60.6% (134/221) (P=0.0091), and also lower, 9.1% (84/925), using combined agents that included cephalosporin for both prophylaxis and therapy than 46.1% (172/373) using single agents (P<0.0001).
  
  
  CONCLUSIONS
  Early referral to reduce emergency operations and timely commencement of combined antimicrobials which includes cephalosporins are advocated.
authors.affiliation: Paediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria.
authors.forename: O D
authors.initials: OD
authors.lastname: Osifo
authors.forename: S E
authors.initials: SE
authors.lastname: Aghahowa
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019990:Perioperative Care; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents