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Antibiotic Prophylaxis for Pyloromyotomy in Children: An Opportunity for Better Stewardship
Kibileri Williams1, Timothy Lautz2,3, Richard J Hendrickson4
1Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20001, USA.
Insights
Antibiotic prophylaxis is commonly given for pediatric pyloromyotomy, a clean surgery, despite low infection rates. This highlights a need for standardized antibiotic stewardship in pediatric surgery.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Antibiotic Stewardship
Background:
- Surgical site infection is rare after pyloromyotomy in children, a procedure classified as "clean."
- The necessity of prophylactic antibiotics for this procedure is debated.
Purpose of the Study:
- To investigate the administration of prophylactic antibiotics for pyloromyotomy in children's hospitals in the USA.
- To identify variations in antibiotic use across institutions.
Main Methods:
- Retrospective review of the Pediatric Health Information System (PHIS) database (2014-2015).
- Included patients under 1 year old diagnosed with pyloric stenosis who underwent pyloromyotomy.
- Extracted data on demographics, length of stay, and perioperative antibiotic administration.
Main Results:
- 4206 patients met the study criteria.
- 51% of patients received perioperative antibiotics, with significant variation among hospitals.
- Over 90% of hospitals administered antibiotics to over 10% of patients; only two hospitals did not use prophylaxis.
Conclusions:
- Prophylactic antibiotics are frequently administered for pyloromyotomy in US children's hospitals, despite it being a clean procedure.
- This practice indicates a need for standardized care protocols.
- Enhanced antibiotic stewardship is crucial in pediatric surgical settings.
Introduction:
Surgical site infection is very uncommon after pyloromyotomy in children, and it is considered a "clean" procedure under the traditional wound classification system. This study aims to investigate prophylactic antibiotic administration for pyloromyotomy among children's hospitals in the USA.
Methods:
The Pediatric Health Information System (PHIS) database was retrospectively reviewed from 2014 to 2015 including all patients less than 1 year old who had a principal diagnosis of pyloric stenosis and underwent pyloromyotomy. Patient demographics, hospital length of stay, and perioperative antibiotic administration were extracted.
Results:
A total of 4206 patients met study criteria. Most patients were male (84%) and Caucasian (70%). The median age at admission was 32 days (IQR 24-44 days), and median length of stay was 2 days (IQR 1-2 days). Antibiotics were administered perioperatively in 2153 (51%) patients with marked variation among children's hospitals. Antibiotics were given to more than 10% of patients in more than 90% of hospitals, and only two of 49 hospitals gave no antibiotic prophylaxis.
Conclusions:
This study has shown that at several tertiary-level children's hospitals in the USA, antibiotic prophylaxis is administered for pyloromyotomy, a "clean" procedure. This highlights the need for standardization of care and more effective antibiotic stewardship in pediatric surgery.
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