Prophylactic Antibiotic use and Outcomes in Infants Undergoing Pyloromyotomy: A Multicenter Propensity Matched Cohort...

Area of Science:

• Pediatric Surgery
• Infectious Disease Prevention

Background:

• Pediatric surgeons vary in their use of prophylactic antibiotics for infant pyloromyotomy.
• Evidence is needed to guide antibiotic prophylaxis practices.

Purpose of the Study:

• To compare surgical site infection (SSI) rates in infants undergoing pyloromyotomy with and without antimicrobial prophylaxis.

Main Methods:

• A multicenter study of 6093 infants undergoing pyloromyotomy from January 2021 to December 2023.
• Patient-level propensity-matched mixed-effects models were used to compare outcomes.
• Hospital-level analysis assessed the correlation between prophylaxis rates and SSI rates.

Main Results:

• Overall SSI rates were similar with or without prophylaxis (1.6% vs. 1.1%).
• Higher institutional prophylaxis rates did not correlate with lower SSI rates.
• Laparoscopic pyloromyotomy showed no SSI benefit from prophylaxis; open repair showed a significant SSI reduction with prophylaxis (5.1% vs. 1.9%).

Conclusions:

• Routine antimicrobial prophylaxis does not decrease SSI rates in infants undergoing laparoscopic pyloromyotomy.
• Selective antimicrobial prophylaxis is indicated for infants undergoing open pyloromyotomy due to higher SSI risk.