Pediatric surgical infection and antibiotic usage.

Surgical infection is unique in that it usually requires operative intervention in conjunction with antibiotic therapy for satisfactory resolution. Prevention of infection is therefore of primary concern to the surgeon, and the majority of antibiotic use is prophylactic. Effective prophylaxis must be based on specific guidelines for patient selection and an awareness of the commonly encountered pathogens. Postoperative wound infection represents the most common surgical infection, and the clinical characteristics frequently suggest the causative bacteria. The majority of these cases respond to local wound therapy alone. Peritonitis and intraabdominal abscess are the most significant surgical infections and are almost invariably the result of intestinal contamination. Therapy must consist sequentially of resuscitation, effective antimicrobial coverage of Escherichia coli, enterococcus and Bacteroides fragiles and operative intervention.