title: Surgical site infections in neonates and infants: is antibiotic prophylaxis needed for longer than 24 h?
abstract: OBJECTIVE
  The purpose is to determine whether use of perioperative antibiotics for more than 24 h decreases the incidence of SSI in neonates and infants.
  
  
  METHODS
  We studied neonates and infants who had clean-contaminated or contaminated gastrointestinal operations from 1996 to 2006. Patient- and operation-related variables, duration of perioperative antibiotics, and SSI within 30 days were ascertained by retrospective chart review. In assessing the effects of antibiotic duration, we controlled for confounding by indication using standard covariate adjustment and propensity score matching.
  
  
  RESULTS
  Among 732 operations, the incidence of SSI was 13%. Using propensity score matching, the odds of SSI were similar (OR 1.1, 95% CI 0.6-1.9) in patients who received ≤24 h of postoperative antibiotics compared to >24 h. No difference was also found in standard covariate adjustment. This multivariate model identified three independent predictors of SSI: preoperative infection (OR 3.9, 95% CI 1.4-10.9) and re-operation through the same incision, both within 30 days (OR 3.5, 95% CI 1.7-7.4) and later (OR 2.3, 95% CI 1.4-3.8).
  
  
  CONCLUSIONS
  In clean-contaminated and contaminated gastrointestinal operations, giving >24 h of postoperative antibiotics offered no protection against SSI. An adequately powered randomized clinical trial is needed to conclusively evaluate longer duration antibiotic prophylaxis.
authors.affiliation: Department of Surgery, University of California, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143-0570, USA, lan.vu@ucsfmedctr.org.
authors.forename: Lan T
authors.initials: LT
authors.lastname: Vu
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Kerilyn K
authors.initials: KK
authors.lastname: Nobuhara
authors.forename: Diana L
authors.initials: DL
authors.lastname: Farmer
authors.forename: Hanmin
authors.initials: H
authors.lastname: Lee
mesh_terms: D019072:Antibiotic Prophylaxis; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome