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

Kerri A McKie1, Anoosha Moturu2, Dionne A Graham3

  • 1Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.

Annals of Surgery
|June 20, 2025
PubMed

Insights

Antimicrobial prophylaxis did not reduce surgical site infections in infants undergoing laparoscopic pyloromyotomy. However, prophylaxis significantly lowered infection rates in infants undergoing open pyloromyotomy, suggesting selective use.

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.
Abstract

Keywords:
Pyloromyotomyantimicrobial prophylaxissurgical site infection

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