Antimicrobial Prophylaxis for Urologic Procedures in Paediatric Patients: A RAND/UCLA Appropriateness Method

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Susanna Esposito1, Erika Rigotti2, Alberto Argentiero1

  • 1Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.

Antibiotics (Basel, Switzerland)
|March 25, 2022
PubMed

Insights

Surgical antimicrobial prophylaxis (SAP) guidelines for pediatric urology are scarce. This consensus provides recommendations for preventing infections during urologic procedures, emphasizing rational antibiotic use and stewardship.

Area of Science:

  • Urology
  • Infectious Disease Prevention
  • Pediatric Surgery

Background:

  • Surgical antimicrobial prophylaxis (SAP) aims to prevent bloodstream infections, surgical site infections (SSIs), and postoperative urinary tract infections (ppUTIs) in urologic procedures.
  • Existing guidelines for SAP in pediatric urology are limited, with practices often based on expert opinion rather than robust evidence.
  • There is a need for evidence-based recommendations to standardize SAP in pediatric urologic procedures.

Purpose of the Study:

  • To establish consensus-based recommendations for SAP in pediatric patients undergoing urologic imaging and surgical procedures.
  • To provide guidance on preventing bacteraemia, SSIs, and ppUTIs.
  • To address the lack of specific guidelines in pediatric urology.

Main Methods:

  • The RAND/UCLA appropriateness method was employed to develop the consensus recommendations.
  • Expert consensus was gathered on key aspects of SAP in pediatric urology.
  • Literature review on existing studies regarding SAP in pediatric urologic procedures was conducted.

Main Results:

  • Experts reached agreement on fundamental concepts for SAP in pediatric urologic procedures.
  • Exclusion of urinary tract infection (UTI) is crucial before any urologic procedure.
  • Clean procedures generally do not require SAP, except for prosthetic device implantation and procedures involving groin/perineal incisions.
  • SAP is indicated for clean-contaminated procedures.
  • Evidence suggests SAP may be safely omitted in pediatric hernia repair and orchiopexy.
  • Reducing and rationalizing antibiotic use for SAP is essential to limit antimicrobial resistance.

Conclusions:

  • Consensus recommendations for SAP in pediatric urology have been established using the RAND/UCLA method.
  • SAP strategies should be tailored based on procedure type, considering infection risk.
  • Emphasis on antibiotic stewardship is critical to combat antimicrobial resistance.

Keywords:
RAND/UCLA methodcystoscopyhypospadiaskidney transplantationnephrolithiasissurgical antimicrobial prophylaxisurology

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