title: Prevention of infectious complications after elective colorectal surgery in children: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee comprehensive review.
abstract: OBJECTIVE
  This goal of this review was to examine the clinical evidence in support of commonly utilized measures intended to reduce complications following elective colorectal surgery.
  
  
  METHODS
  Literature searches were performed to identify relevant studies from Medline, PubMed, and Cochrane databases.
  
  
  METHODS
  The American Pediatric Surgery Association Outcomes and Clinical Trials Committee selected eight questions to address this topic systematically in the context of three management areas: 1) appropriate utilization of systemic antibiotics for colorectal procedures, 2) reduction of stool burden through mechanical bowel preparation, and 3) intraluminal gut decontamination through use of enteral nonabsorbable antibiotics. Primary outcomes of interest included the occurrence of infectious and mechanical complications related to stool burden and intraluminal bacterial concentration (incisional surgical site infection, anastomotic leakage, and intraabdominal abscess).
  
  
  RESULTS
  The evidence in support of each management category was systematically reviewed, graded, and summarized in the context of the review's primary outcomes. Practice recommendations were made as deemed appropriate by the committee.
  
  
  CONCLUSIONS
  Clinical evidence in support of interventions to reduce infectious complications following colorectal surgery is derived almost exclusively from the adult literature. High-quality evidence to guide clinical practice in children is sorely needed, as the available data may have only limited relevance to pediatric colorectal diseases.
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: shawn.rangel@childrens.harvard.edu.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.affiliation: University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Saleem
authors.initials: S
authors.lastname: Islam
authors.affiliation: Children's Mercy Hospital, University of Missouri, Kansas City, MO, USA.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: University of Louisville, Louisville, KY, USA.
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Downard
authors.affiliation: St. Louis Children's Hospital, Washington University, St. Louis, MO, USA.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Saito
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.affiliation: Montreal Children's Hospital, Montreal, QC, Canada.
authors.forename: Pramod S
authors.initials: PS
authors.lastname: Puligandla
authors.affiliation: Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Roshni
authors.initials: R
authors.lastname: Dasgupta
authors.affiliation: Children's Memorial Hermann Hospital, University of Texas, Houston, TX, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Austin
authors.affiliation: Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Li Ern
authors.initials: LE
authors.lastname: Chen
authors.affiliation: Children's Hospital at Montefiore, Bronx, NY, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Renaud
authors.affiliation: Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Marjorie J
authors.initials: MJ
authors.lastname: Arca
authors.affiliation: Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Casey M
authors.initials: CM
authors.lastname: Calkins
mesh_terms: D026683:Advisory Committees; D002648:Child; D003108:Colonic Diseases / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D011300:Preoperative Care / Q000379:methods*; D012002:Rectal Diseases / Q000601:surgery*; D012955:Societies, Medical; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology
keywords: Anastomotic leakage; Antibiotic prophylaxis; Colorectal surgery; Deep-space infection; Infection control and prevention; Intra-abdominal abscess; Mechanical bowel preparation; Surgical site infection; Wound infection