Use and institutional variation in surgical antibiotic prophylaxis for pediatric clean (class I) penile and groin
Brendan T Frainey1, Isabella Zaniletti2, Leslie M Peard3
1Department of Urology, Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Surgical antibiotic prophylaxis (SAP) is used in 14% of pediatric urologic procedures, despite guidelines against it for clean wounds. Use varies significantly by hospital and procedure type, indicating a need for standardized antimicrobial stewardship.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Antimicrobial Stewardship
Background:
- Ambulatory pediatric penile, inguinal, and scrotal procedures are typically clean (Class I) surgical wounds.
- Guidelines generally do not recommend surgical antibiotic prophylaxis (SAP) for these low-risk cases.
- Limited data exist on SAP utilization and outcomes in pediatric urology.
Purpose of the Study:
- To assess national and hospital-level SAP utilization for common, low-risk ambulatory pediatric urologic procedures.
- To identify factors associated with SAP use in these procedures.
- To evaluate secondary outcomes related to SAP use.
Main Methods:
- Analysis of the Pediatric Health Information System (PHIS) database from 2016-2023.
- Inclusion of males aged 29 days to 18 years undergoing outpatient penile and/or groin procedures.
- Multivariable logistic regression with generalized estimating equations to identify factors associated with SAP use and compare outcomes.
Main Results:
- 108,419 procedures were analyzed; 14% received SAP.
- Groin procedures (19%) had higher SAP use than penile procedures (8%).
- Factors associated with increased SAP use included groin procedures, older age, and urologist as proceduralist; secondary outcomes were similar between groups.
Conclusions:
- SAP use for uncomplicated pediatric urologic procedures remains prevalent at 14%, with substantial inter-hospital variability.
- Groin procedures, older patients, and urologists performing procedures are linked to higher SAP rates.
- Standardization of SAP practices is needed to balance SSI prevention with antimicrobial stewardship.
Background:
The majority of ambulatory pediatric penile, inguinal and scrotal cases are considered clean (class I) surgical wounds and guidelines do not recommend surgical antibiotic prophylaxis (SAP) use. Despite these recommendations, few data exist that have assessed utilization and outcomes of interest associated with SAP use for ambulatory pediatric urology procedures.
Objective:
To better understand national and individual hospital utilization of SAP for common, ambulatory pediatric urologic procedures at lowest risk for surgical site infection (SSI) and for which the benefits of SAP are limited.
Study Design:
We queried the Pediatric Health Information System (PHIS) database for males (29 days-18 years) undergoing outpatient penile and/or "groin" (inguinal/scrotal) procedures from 2016 to 2023. SAP use was abstracted. Demographic and clinical characteristics were compared between procedures with no SAP use vs. any SAP use and a multivariable logistic regression model with generalized estimating equation to account for clustered data on hospitals was performed to identify factors associated with increased odds of use. Secondary outcomes of interest included post-operative ED visits, surgical site infections, allergic reactions, and Clostridium difficile infections. National trends in SAP use were compared by year and between hospitals that consistently reported data over the study period.
Results:
A total of 108,419 procedures (46 % penile, 42 % groin, 12 % combination) were included. Median age at surgery was 2 (IQR 0,7) years. Overall, 14 % of procedures had SAP use. Groin procedures had higher rates of antibiotic use compared to penile procedures (19 % vs 8 %, p < 0.001). On adjusted analysis, groin procedures (aOR 2.12), combined groin + penile procedures (aOR 2.43), older age (aOR 2.54), and urologist as proceduralist (aOR 1.52) were independently associated with greater odds of antibiotic use. Rates of secondary outcomes were similar between groups. There was significant variability in SAP between centers (range 0 %-32 % groin; 0 %-16.7 % penile, p < 0.001) over the study period (Figure 1B).
Discussion:
SAP use for uncomplicated pediatric penile and groin procedures was 14 % overall, with variability in use between hospitals. Groin procedures, older patients, and a urologic proceduralist were associated with increased odds of antibiotic use.
Conclusion:
Despite improvements over time, SAP use persists for uncomplicated, clean pediatric urologic procedures, with significant variability across centers. This highlights an opportunity for standardization of practice within pediatric urology to optimize the balance between SSI prevention and promotion of antimicrobial stewardship.
Related Concept Videos
01:23Hand hygiene
Hand washing...
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...