Antimicrobial Prophylaxis Use and Outcomes for Children Undergoing Cholecystectomy

Area of Science:

• Pediatric Surgery
• Infectious Diseases
• Surgical Quality Improvement

Background:

• Current guidelines against antimicrobial prophylaxis for uncomplicated cholelithiasis are based on adult data.
• Pediatric surgical populations may have different responses to prophylaxis.

Purpose of the Study:

• To compare surgical site infection (SSI) outcomes in children undergoing cholecystectomy with and without antimicrobial prophylaxis.
• To evaluate the impact of extended-spectrum versus standard-spectrum prophylaxis.

Main Methods:

• A cohort study of 2234 children undergoing cholecystectomy from 141 hospitals in the National Surgical Quality Improvement Program-Pediatric.
• Propensity score weighting was used to balance groups and logistic regression models estimated the association between prophylaxis and outcomes.
• Exclusion criteria included acute cholecystitis, pancreatitis, choledocholithiasis, hematologic disorders, and emergent procedures.

Main Results:

• Children receiving prophylaxis had significantly lower SSI rates (0.9%) compared to those who did not (3.7%).
• The adjusted odds ratio for SSI with prophylaxis was 0.28 (95% CI, 0.11-0.70).
• No significant difference in SSI rates was observed between cefazolin and extended-spectrum antibiotics.

Conclusions:

• Antimicrobial prophylaxis is associated with reduced SSI rates in children undergoing nonemergent cholecystectomy.
• Cefazolin appears to be as effective as extended-spectrum antibiotics for prophylaxis in this population.
• Opportunities exist to optimize infection prevention and antimicrobial stewardship in pediatric cholecystectomy.