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Review of Perioperative Prophylactic Antibiotic Use during Laparoscopic Cholecystectomy and Subsequent Surgical Site
Kayla B Briggs1, James A Fraser1, Wendy Jo Svetanoff1
1Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States.
Insights
Prophylactic preoperative antibiotics (PPA) were used in 60% of pediatric laparoscopic cholecystectomies, with lower surgical site infection (SSI) rates in those receiving PPA. Conservative PPA use is recommended to combat antibiotic resistance.
Area of Science:
- Pediatric Surgery
- Infectious Disease
- Antibiotic Resistance
Background:
- The increasing prevalence of antibiotic resistance necessitates a re-evaluation of prophylactic preoperative antibiotic (PPA) use.
- Surgical site infections (SSI) are a concern, but their rates and the necessity of PPA in specific procedures are debated.
Purpose of the Study:
- To analyze the utilization of PPA and the incidence of SSI in pediatric patients undergoing elective laparoscopic cholecystectomy.
- To assess the impact of PPA on SSI rates in this specific patient population.
Main Methods:
- A retrospective chart review was conducted on pediatric patients (<18 years) who underwent elective outpatient laparoscopic cholecystectomy from July 2010 to August 2020.
- Data collected included demographics, preoperative details, antibiotic administration, intraoperative factors, and SSI occurrence within 30 days post-surgery.
Main Results:
- Of 502 patients, 60% received PPA. The SSI rate was 1.3% in the PPA group versus 5.5% in the no-PPA group (p=0.01).
- Multivariate analysis indicated PPA use was associated with a 77% reduction in SSI risk (p=0.01).
- All identified SSIs were superficial, with most managed on an outpatient basis.
Conclusions:
- While PPA use was linked to reduced SSI risk in this pediatric cohort, the low morbidity of superficial infections suggests a conservative approach.
- Judicious use of PPA is advised to mitigate the broader issue of antibiotic resistance.
Objectives:
With the rise of antibiotic resistance, the use of prophylactic preoperative antibiotics (PPA) has been questioned in cases with low rates of surgical site infection (SSI). We report PPA usage and SSI rates after elective laparoscopic cholecystectomy at our institution.
Materials And Methods:
A retrospective review of children younger than 18 years who underwent elective outpatient laparoscopic cholecystectomy between July 2010 and August 2020 was performed. Demographic, preoperative work-up, antibiotic use, intraoperative characteristics, and SSI data were collected via chart review. SSI was defined as clinical signs of infection that required antibiotics within 30 days of surgery.
Results:
A total of 502 patients met the inclusion criteria; 50% were preoperatively diagnosed with symptomatic cholelithiasis, 47% with biliary dyskinesia, 2% with hyperkinetic gallbladder, and 1% with gallbladder polyp(s). The majority were female (78%) and Caucasian (80%). In total, 60% (n = 301) of patients received PPA, while 40% (n = 201) did not; 1.3% (n = 4) of those who received PPA developed SSI, compared with 5.5% (n = 11) of those who did not receive PPA (p = 0.01). Though PPA use was associated with a 77% reduction in the risk of SSI in multivariate analysis (p = 0.01), all SSIs were superficial. One child required readmission for intravenous antibiotics, while the remainder were treated with outpatient antibiotics. Gender, age, body mass index, ethnicity, and preoperative diagnosis did not influence the likelihood of receiving PPA.
Conclusion:
Given the relatively low morbidity of the superficial SSI, conservative use of PPA is advised to avoid contributing to antibiotic resistance.
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