Purpose:The purpose of this study was to determine the best wound infection p rophylaxis in pediatric acute appendicitis.Methods:From 1969 to 1995 inclusive,453 consecutive pediatric patients at the same children’s hospital had an app endix with acute inflammation(acute appendicitis)removed by the same staff sur geon and his resident.The stump was not inverted,and chromic catgut was used t hroughout.No intraperitoneal antibiotics,irrigation,or drains were used,and the skin closure was with silk sutures initially and then with staples since 198 6.The infants and children were divided into 6 consecutive groups of 52 to 96 p atients,with each group lasting 2 to 5 years.The wound treatment groups were a s follows:no treatment,drain or pack,drain or pack plus antibiotic powder,an tibiotic powder,preoperative intravenous antibiotic plus antibiotic powder,and preoperative intravenous antibiotic.The wound Penrose drain,one half-inch ga uze pack,and/or antibiotic powder(ampicillin,1977-1981;cefoxitin,1982-199 5)were all placed in the subcutaneous space.Results:There were a total of 50(11%)wound infections(pus)that occurred between 4 and 40 days when no antibi otic powder was used and 2 to 14 days with antibiotic powder.In all 6 groups of patients,no organism was grown in most(80%)infections and Escherichia coli was the second commonest(12%).The serous ooze,which occurred only with the u se of antibiotic powder(8%),was seen between 6 and 18 days,and no organism w as ever cultured.Conclusions:The patients with preoperative(or intraoperative)intravenous antibiotics(cefoxitin)pluswound antibiotic powder(cefoxitin)ha d the lowest infection rate(2.5%).When this group was compared with the basel ine group 1(no treatment),it was the only group in which wound treatment made a significant difference(P =0.003).
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