Rational perioperative antibiotic prophylaxis for open damages of brush in children

Abstract

Introduction. Today, hand injuries are one of the most pressing and common problems in modern traumatology worldwide. Results obtained statistically indicate a fairly high frequency of hand injuries, including open ones. Often, an incorrect prescription of antibiotics in the form of unjustified antibiotic therapy in the absence of direct indications is done.

Aim. This study aimed to develop a rational algorithm for perioperative antibiotic prophylaxis for open hand injuries in children based on experimental and clinical research.

Materials and methods. The study was divided into two phases: experimental and clinical. The experiment was carried out on 60 sexually mature, outbred guinea pigs. During the experiment, the analysis of clinical signs of inflammation, complete blood count and biochemical blood analysis, spiral computed tomography, and morphological study of the consolidation zone were performed. The clinical part of the work is based on the analysis of surgical treatment results of 120 children with open hand injuries, which were divided into two groups: the main group that included 50 children receiving treatment according to the experimentally developed perioperative antibiotic prophylaxis (PAP) algorithm, and the comparison group included 70 children receiving a perioperative course of antibiotics from 0 to 7 days, without a well-defined algorithm.

Results. In the analysis of clinical results, laboratory, radiation, and morphological methods of studying the experimental material, the absence of antibiotic prophylaxis in open fractures of small tubular bones with a 90% probability was found to entail pro-inflammatory complications in the area of postoperative wound; however, a one day short-term course of PAP will prevent complications and will not have statistically significant differences with a longer course of three days.

Discussion. Results of a clinical study proved the effectiveness of the developed algorithm and showed better results in early and late postoperative period in comparison with the chaotic prescription of antibacterial drugs without a clear algorithm; however, no statistically significant differences in the level of postoperative complications were found.

Conclusion. On the basis of an experimental model of an open fracture of the tubular bone, osteosynthesis and various courses of antibiotic prophylaxis has proven that a short-term course of PAP within 24 h is the most optimal one, and achieving minimal risks of inflammatory complications and better anatomical and functional outcomes in clinical practice.

Keywords

antibiotic prophylaxis / open fracture / hand injury / children

References

[1] Kwak D, Lee S, Yoo J, et al. Difference in the epidemiologic and clinical characteristics by age groups of the children who visited a hand center emergency department with a hand injury requiring surgery. Pediatr Emerg Med J. 2016;3(2):53–58. https://doi.org/10.22470/pemj.2016.3.2.53

[2] Ruta D, Ozer K. Open Fractures of the Hand with Soft Tissue Loss. Hand Clinics. 2013;29(4):551–567. https://doi.org/10.1016/j.hcl.2013.08.008

[3] Корюков А.А., Губин А.В., Кузнецов В.П., и др. Возможности улучшения функции косметики культей пальцев кисти методом оссеоинтеграции // Гений ортопедии. — 2016. — № 4. — C. 22–28. [Koryukov AA, Gubin AV, Kuznetsov VP, et al. Possibilities of improving the function and esthetic appearance of finger stumps using the method of osseointegration. Genij Orthopedii. 2016;(4):22–28. (In Russ.)] https://doi.org/10.18019/1028-4427-2016-4-22-28

[4] Голубев И.О., Гришин В.М. Задний межкостный лоскут предплечья в реконструкции кисти у детей // Травматология и ортопедия России. — 2014. — № 2. — С. 62–67. [Golubev IO, Grishin M. Posterior interosseous flap in pediatric hand reconstructions. Traumatology and Orthopedics of Russia. 2014;(2):62–67. (In Russ.)] https://doi.org/10.21823/2311-2905-2014-0-2-62-67

[5] Токарев А.Е., Козюков В.Г. Первичные восстановительные операции при открытых повреждениях кисти пальцев, направленные на восстановление функции захвата // Пермский медицинский журнал. — 2013. — Т. 30. — № 3. — С. 41–45. [Tokarev AE, Kozyukov VG. Primary plastic operations for open hand and fingers injuries directed to restoration of grasp function. Perm Medical Journal. 2013;30(3):41–45. (In Russ.)]

[6] Yorlets RR, Busa K, Eberlin KR, et al. Fingertip injuries in children: epidemiology, financial burden, and implications for prevention. Hand (NY). 2017;12(4):342–347. ttps://doi.org/10.1177/1558944716670139

[7] Al-Anazi AF. Fingertip injuries in pediatric patients — experiences at an emergency center in Saudi Arabia. J Pak Med Assoc. 2013;63(6):675–679

[8] Liu WH, Lok J, Lau MS. et al. Mechanism and epidemiology of pediatric finger injuries at Prince of Wales Hospital in Hong Kong. Hong Kong Med J. 2015;21(3):237–242. https://doi.org/10.12809/hkmj144344

[9] Mirzaie M, Parsa A, Salehi M, et al. Epidemiology of hand injuries in children presenting to an orthopedic trauma center in southeast of Iran. Arch Bone Jt Surg. 2014;2(3):225–231.

[10] Minhas SV, Catalano LW. Comparison of Open and Closed Hand Fractures and the Effect of Urgent Operative Intervention. J Hand Surg Am. 2019;44(1):65.e1–65.e7. https://doi.org/10.1016/j.jhsa.2018.04.032

[11] Bannasch H, Heermann AK, Iblher N, et al. Ten years stable internal fixation of metacarpal and phalangeal hand fractures — risk factor and outcome analysis show no increase of complications in the treatment of open compared with closed fractures. J Trauma. 2010;68(3):624–628. https://doi.org/10.1097/TA.0b013e3181bb8ea0

[12] Skaggs DL, Friend L, Alman B, et al. The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Joint Surg Am. 2005;87(1):8–12. https://doi.org/10.2106/JBJS.C.01561.

[13] Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128(6):1053–1061. https://doi.org/10.1542/peds.2011-1337

[14] Тихонов А.Н., Судаков Д.В., Белов Е.В., Шевцов А.Н. Антибиотикорезистентность в травматологии // Центральный научный вестник. — 2018. — Т. 3 — № 23. — С. 15–17. [Tikhonov AN, Sudakov DV, Belov EV, Shevtsov AN. Antibiotic resistance in traumatology. Central science bulletin. 2018;3(23):15–17. (In Russ.)]

[15] Hass H, Launay E, Minodier P, et al. Surgical and medical antibiotic prophylaxis. Arch Pédiatr. 2017;24(12):S46–S51. https://doi.org/10.1016/S0929-693X(17)30519-5

[16] Руднов В.А., Колотова Г.Б., Багин В.А., и др. Роль управления антимикробной терапией в службе реанимации и интенсивной терапии многопрофильного стационара // Клиническая микробиология и антимикробная химиотерапия. — 2018. — Т. 20 — № 2. — С. 132–140. [Rudnov VA, Kolotova GB, Bagin VA, et al. The role of antimicrobial therapy stewardship in intensive care service. Clinical Microbiology and Antimicrobial Chemotherapy. 2018;20(2):132–140.(In Russ.)]

[17] Патент РФ на изобретение № 2717217/ 18.03.2020. Бюл. № 8. Гордиенко И.И., Борисов С.А., Цап Н.А. Способ моделирования и лечения открытого перелома трубчатой кости в эксперименте. [Patent RU 2717217/ 18.03.2020. Byul. No. 8. Gordienko II, Borisov SA, Tsap NA. Method of modeling and treatment of open fracture of tubular bone in experiment. Режим доступа: https://patenton.ru/patent/RU2717217C1. Дата обращения: 12.12.20.

[18] Гордиенко И.И., Борисов С.А., Цап Н.А. Алгоритм антибиотикопрофилактики при открытых переломах трубчатых костей. Экспериментальное исследование // Вестник экспериментальной и клинической хирургии. — 2019. — Т. 12 — № 3. — С. 187–192. [Gordienko II, Borisov SA, Tsap NA. The antibiotic prophylaxis algorithm for open hand injuries in children. Experimental study. Journal of Experimental and Clinical Surgery. 2019;12(3):187–192. (In Russ.)] https://doi.org/10.18499/2070-478X-2019-12-3-187-192

[19] Гордиенко И.И., Цап Н.А. Периоперационная антибиотикопрофилактика при открытых травмах кисти у детей // Доктор.Ру. — 2019. — № 5 — С. 34–37 [Gordienko II, Tsap NA. Perioperative Antibiotic Prophylaxis in Open Hand Injuries in Children. Doctor.Ru. 2019;(5):34–37. (In Russ.)] https://doi.org/10.31550/1727-2378-2019-160-5-34-37

[20] Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608. https://doi.org/10.1002/(SICI)1097-0274(199606)29:63.0.CO;2-L

RIGHTS & PERMISSIONS

Gordienko I.I., Tsap N.A.