Perioperative antibiotic prophylaxis in adolescent fracture surgery: results of a national survey of German paediatric and trauma surgeons

Abstract Objectives The use of perioperative antibiotic prophylaxis (PAP) for prevention of surgical site infections (SSI) is an established procedure for many surgical interventions. The management of fractures in adolescents represents a distinct subgroup. Currently, there are no evidence-based recommendations for this population. Surgery is performed by paediatric and trauma surgeons. Consequently, there is likely to be considerable variation in the use of PAP. In order to reflect current care practices, a cross-sectional study of self-reported practice patterns was conducted. Methods A questionnaire was sent to German paediatric and trauma surgeons. The substance of PAP and the indications for the use of PAP in various adolescent fracture treatments (closed or open reduction in combination with various osteosynthetic techniques – e.g. K-wires, ESINs, screws, plates) were asked. The differences were statistically analysed. Results In total, 126 respondents (48 trauma surgeons and 78 paediatric surgeons – including 7 specialised in both) could be included in the survey. The choice of the drug as well as the decision to apply PAP itself in adolescent trauma treatment was vastly depending on the surgeon’s speciality and, furthermore, not standardised within the speciality. The use of PAP among trauma surgeons is significantly higher than among paediatric surgeons for almost all types of fracture treatment. The greatest difference can be seen with closed reduction, e.g. with simultaneous elastic stable intramedullary nailing (ESIN) (paed: 24.3 %, 19/78; trauma: 87.5 %, 42/48; p<0.01). Conclusions This survey highlights the lack of consensus between paediatric and trauma surgeons regarding perioperative antibiotic prophylaxis in adolescent fracture surgery and underscores the need for prospective outcome–based studies to establish risk-adapted strategies.