Antibiotic treatment before a pediatric elbow fracture surgery does not lower the chances of post-operative infection, according to new research from the University of Missouri School of Medicine. A common injury for children who fall is a humerus bone fracture near the elbow. The usual surgical method for repairing these fractures is a procedure known as closed reduction percutaneouspinning (CRPP). This procedure involves the insertion of pins or wires through the skin to promote stability and healing of the bone. While CRPP is considered to be a minimally invasive, safe, and effective procedure, there is a risk of post-operative infections occurring in a small number of cases. In an effort to prevent infections from occurring after surgery, some physicians may choose to pre-treat the patient with antibiotics.
In a recent randomized trial conducted by MU researchers, the effectiveness of preoperative, preventative antibiotic treatment in reducing infection rates following CRPP was tested. The results of the trial showed that whether the patient was treated with prophylactic antibiot
Sumit Gupta, MD, division chief of Pediatric Orthopaedics and associate professor of orthopaedic surgery at the School of Medicine, led a study involving 160 patients. They were randomly assigned to either receive pre-surgical antibiotics or a placebo. The study found that the infection rate in those treated with the placebo was only 0.1% higher than in the treatment group. In both groups, the infection rate was very low, only 1.2% to 1.3% respectively.
Gupta commented, “The evidence suggests there is no need for pre-surgical antibiotic treatment in these types of cases.”
As the problem of antimicrobial resistance grows, the need for responsible use of antibiotics becomes crucial in order to maintain the effectiveness and benefits of these life-saving medications.”
The current recommendations for clinical practice, established by a collaborative panel including the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Surgical Infection Society, and the Society for Healthcare Epidemiology of America, have recognized that the necessity of pre-surgical antibiotics is not well defined.
“Our research results offer valuable insights that can be utilized in the creation of new, evidence-based guidelines to assist in surgical procedures.Dr. Daniel Hoernschemeyer, the medical director of Pediatric Procedural Services and an associate professor of clinical orthopaedic surgery at the School of Medicine, emphasized the importance of using antibiotics appropriately. He stated that antibiotics should only be used to treat actual infections. A study titled “Effect of Antibiotic Prophylaxis on Infection Rates in Pediatric Supracondylar Humerus Fractures Treated with Closed Reduction and Percutaneous Pinning: A Prospective Double-Blinded Randomized Controlled Trial” was recently published in the Journal of the American Academy of Orthopaedic Surgeons. This study investigated the impact of antibiotic prophylaxis on infection rates in pediatric patients with supracondylar humerus fractures.pta, and Hoernschemeyer, from the University of Missouri, conducted research that included Emily Leary, PhD, the director of orthopaedic biostatistics in the Department of Orthopaedic Surgery; Ennio Rizzo Esposito, MD, Rachel Phillips, MD, and Pierre-Emmanuel Schwab, MD, also from the Department of Orthopaedic Surgery.
