Dr Ein and colleagues determined the best wound infection prophylaxis in pediatric acute appendicitis.
From 1969 to 1995 inclusive, 453 consecutive pediatric patients at the same children's hospital had an appendix with acute inflammation.
The appendices were removed by the same staff surgeon and his resident.
The stump was not inverted, and chromic catgut was used throughout.
No intraperitoneal antibiotics, irrigation, or drains were used, and the skin closure was with silk sutures initially and then with staples since 1986.
The researchers divided infants and children into 6 consecutive groups of 52 to 96 patients, with each group lasting 2 to 5 years.
The wound treatment groups included no treatment, drain or pack, drain or pack plus antibiotic powder, and antibiotic powder.
|11% of wound infections occurred between 4 and 40 days without antibiotic powder use|
|Journal of Pediatric Surgery|
In addition, preoperative intravenous antibiotic plus antibiotic powder was included in the wound treatment group.
The wound Penrose drain, a half-inch gauze pack, and/or antibiotic powder were all placed in the subcutaneous space.
The researchers found that 11% of wound infections occurred between 4 and 40 days when no antibiotic powder was used and 2 to 14 days with antibiotic powder.
In all 6 groups of patients, no organism was grown in most, or 80% of infections.
The team noted that Escherichia coli was the second commonest organism found in 12% of infections.
The serous ooze, which occurred only with the use of antibiotic powder, was seen between 6 and 18 days, and no organism was ever cultured.
Dr Ein's team concluded, “The patients with preoperative or intraoperative intravenous antibiotics plus wound antibiotic powder had the lowest infection rate.
“When this group was compared with the baseline group receiving no treatment, it was the only group in which wound treatment made a significant difference.”