Influence of Body Mass Index and Antibiotic Dose on the Risk of Surgical Site Infections in Pediatric Clean Orthopedic Surgery

Objective: To evaluate body mass index (BMI) and antimicrobial dose as risk factors for surgical site infections in pediatric patients. Patients and Methods: Children between 2 and 19 years of age undergoing clean orthopedic procedures and receiving at least one dose of perioperative antibiotics (cefazolin, vancomycin, or clindamycin) were studied. The retrospective case-controlled study was conducted at the Alfred I. duPont Hospital for Children, a 180-bed tertiary-care academic pediatric hospital in Wilmington, DE. Data were collected from January 1, 2002, to December 31, 2005. Results: Underweight children had a higher risk for SSIs than overweight and normal-weight children. American Society of Anesthesiologists classes II and greater were associated with a greater risk of SSI. Longer procedures were also associated with a higher risk of SSI, specifically, duration of surgery >2 h. Children weighing 70 kg who received a standard dose of cefazolin (maximum of 1 g) had a higher risk of SSI caused by methicillin-sensitive Staphylococcus aureus (MSSA). Conclusions: Being underweight and undergoing an operation lasting >2 h created significant risks for SSI. Children weighing >= 70 kg receiving a standard 1-g dose of cefazolin had a greater risk of MSSA SSIs than children weighing <70 kg who received an appropriate weight-based dose of this antibiotic.