Surgical Antibiotic Prophylaxis in Children Undergoing Surgery: A Systematic Review and Meta-Analysis

Reevaluating Surgical Antibiotic Prophylaxis in Pediatric Pyloromyotomy: Insights From the NSQIP-Pediatric Database

BACKGROUND

Pyloromyotomy is a clean surgical procedure with a low risk of surgical site infections (SSIs). Despite this, surgical antibiotic prophylaxis (SAP) is often administered, raising concerns about unnecessary antibiotic exposure and antimicrobial resistance. This study aims to evaluate whether SAP reduces SSI rates in infants undergoing pyloromyotomy for hypertrophic pyloric stenosis and to propose a guideline for selective SAP omission.

METHODS

This retrospective cohort study analyzed data from the National Surgical Quality Improvement Program-Pediatric database. Infants undergoing pyloromyotomy between January 1, 2021 and December 31, 2023 were included. The primary outcome was the occurrence of SSIs within 30 days postoperatively. Secondary outcomes included stratified rates of superficial, deep incisional, and organ/space SSIs.

RESULTS

Among 4917 infants (age <1 year; 84.26 % male), 49.48 % received SAP. Additionally, 81 patients (1.65 %) received post-operative antibiotics beyond the intraoperative period. The overall SSI rate was 1.42 %, primarily comprised of superficial SSIs. There was no significant difference in SSI rates between infants receiving SAP (1.15 %) and those not receiving SAP (1.69 %) (p = 0.110). The rate of unplanned readmission and unplanned return to the operating room within 30 days was 2.44 % and 1.04 %, respectively, with no significant difference between those who received post-operative antibiotics and those who did not (p > 0.2 for both comparisons).

CONCLUSIONS

Routine SAP administration in pyloromyotomy is unnecessary given the low risk of SSIs. SAP in ASA Class I or II infants undergoing isolated pyloromyotomy without mucosal perforation, immune-compromising conditions, infections, or trauma should be omitted. These findings support efforts to optimize antibiotic stewardship in pediatric surgical practice.

TYPE OF STUDY

Original Research Article.

LEVEL OF EVIDENCE

III.

Trends in Antibiotic Use in a Large Children's Hospital in London (United Kingdom): 5 Years of Point Prevalence Surveys

Background: Antibiotics are commonly prescribed in paediatrics. As their excessive use contributes to adverse drug events, increased healthcare costs, and antimicrobial resistance, antimicrobial stewardship initiatives are essential to optimising medical care. These single-centre point prevalence surveys aimed to provide insights into antibiotic prescribing trends and identify targets for paediatric AMS activities. Methods: 14 point prevalence surveys were conducted from March 2016-April 2021, collecting data on antibiotic prescriptions, indication, adherence to guidelines, and route of administration. The UK adapted the World Health Organisation's AWaRe classification-guided antibiotic categorization. Results: 32.5% of all inpatients were on at least one antimicrobial; this remained stable during all surveys (range: 20-44%, p = 0.448). Of all prescriptions, 67.2% had an end- or review-date, and the majority was for agents in the Watch category (46.8-70.5%). Amoxicillin and clavulanate were the most frequently prescribed antibiotics (20.8%), followed by gentamicin (15.3%). Approximately 28.8% of all prescriptions were for prophylactic indications, while 7.6% of the prescriptions were not adherent to the hospital guidelines. Conclusions: This study highlights the importance of ongoing monitoring and robust AMS initiatives to ensure prudent antibiotic prescribing in paediatric healthcare. It underscores the need for tailored guidelines, educational efforts, and targeted interventions to enhance the quality of antibiotic usage, ultimately benefiting both individual patients and public health.