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Antibiotic Prophylaxis for Gastrointestinal Surgery among Neonates and Very Young Infants: National Patterns,
Humza Thobani1, Roshni Mathew2, Anam N Ehsan1
1Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA.
Insights
Adherence to surgical antibiotic prophylaxis guidelines is low in infants undergoing GI surgery. Broadening antibiotic coverage offers limited benefit for reducing surgical site infections in this population.
Area of Science:
- Pediatric Surgery
- Infectious Disease
- Antimicrobial Stewardship
Background:
- Surgical antibiotic prophylaxis (SAP) guidelines aim to prevent surgical site infections (SSIs).
- Adherence to SAP guidelines in neonates and infants undergoing gastrointestinal surgery is not well-established.
- Optimizing SAP is crucial for balancing infection prevention and antimicrobial resistance.
Purpose of the Study:
- To evaluate nationwide adherence to surgical antibiotic prophylaxis (SAP) guidelines in neonates and infants undergoing gastrointestinal surgery.
- To assess the association between SAP guideline adherence and surgical site infection (SSI) rates.
- To determine the impact of SAP overcoverage and undercoverage on postoperative outcomes.
Main Methods:
- Utilized the National Surgical Quality Improvement Program-Pediatric database (2021-2023).
- Included patients <90 days old undergoing select thoracoabdominal procedures.
- Classified SAP regimens as adherent, undercoverage, or overcoverage; analyzed SSI as the primary outcome.
Main Results:
- Overall SAP adherence was 87.2% in 11,062 cases.
- Overcoverage and undercoverage rates varied significantly by procedure type.
- SAP undercoverage was linked to higher SSI odds only in colorectal procedures (cefazolin monotherapy); overcoverage did not reduce SSI rates.
Conclusions:
- Nationwide adherence to empiric SAP guidelines is suboptimal in neonates and young infants.
- Broadening SAP coverage offers limited benefit for reducing SSIs in this patient group.
- Neonatal-specific data should guide SAP recommendations to optimize outcomes and antimicrobial stewardship.
Objective:
To evaluate nationwide adherence to surgical antibiotic prophylaxis (SAP) guidelines and its association with outcomes following gastrointestinal surgeries among neonates and infants.
Study Design:
We queried the National Surgical Quality Improvement Program-Pediatric for all patients age <90 days undergoing select thoracoabdominal surgical procedures between 2021 and 2023. Procedures were further subcategorized by anatomic site. SAP regimens were classified as being "adherent," "undercoverage," or "overcoverage" per established guidelines and expert consensus. The primary outcome was surgical site infection (SSI). Associations between SAP classification and SSI rates for each procedure subcategory were analyzed, with further subset analyses to delineate the effects of common SAP regimens on postoperative outcomes.
Results:
A total of 11 062 cases met criteria, with an overall SAP adherence of 87.2%. Rates of overcoverage (2.8%-55.5%) and undercoverage (2.8%-28.3%) varied widely by procedure type. SAP undercoverage did not increase the odds of SSI for most procedures analyzed, with the exception of patients undergoing colorectal procedures, in whom cefazolin monotherapy (undercoverage) was associated with higher odds of SSI (OR = 2.17, 95% CI = 1.08-4.18). Broadening SAP coverage (overcoverage) and prolonging SAP duration were not associated with reduced SSI rates for any subcategory of procedure.
Conclusions:
Adherence to empiric SAP guidelines was poor among neonates and very young infants undergoing surgical intervention. There appears to be limited benefit to broadening SAP coverage for surgery in this patient population. These findings underscore the need for increased adherence to recommendations driven by neonatal-specific data, aiming to balance optimized postoperative outcomes with antimicrobial stewardship goals.
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