Mechanical Bowel Preparation With Oral Antibiotics in Kids: A Necessary Step or Unnecessary Burden?

Mechanical bowel preparation with oral antibiotics (MBP+OA) is recommended in elective adult colorectal surgery to reduce surgical site infections (SSIs); however, pediatric-specific evidence is limited. MBP+OA includes additional barriers (preadmission and nasogastric (NG) tube placement). This study aimed to evaluate the association between MBP+OA and SSI compared to MBP alone or no bowel preparation (NBP).

A retrospective study was conducted of non-neonatal pediatric patients (<18 y) who underwent elective colostomy takedown (January 2014-March 2024). Demographics, medical history, primary diagnosis, antibiotic use, bowel preparation, NG tube placement, and 30-d SSI were collected. Statistical analysis was performed using Chi-squared, Mann-Whitney U, and frequentist and Bayesian logistic regression.

One hundred patients were included with a median age of 10.5 mo (interquartile range 7-14 mo); 62% were male. MBP+OA was used in 61% of cases; all were preadmitted, and 80% were administered via NG tube. The total SSI rate was 19%, 20% in NBP, and 20% in MBP+OA (P = 0.91). When adjusting for gender, antibiotic use within 14 d, continued antibiotic use postoperatively, and preoperative rectal irrigations, there was no difference in composite SSI between MBP+OA and NBP (odds ratio 0.78, 95% confidence interval 0.23-2.63), with a 58% Bayesian probability of benefit. Organ space infection occurred in three patients, all in the NBP, with a 99% Bayesian probability of benefit.

Optimal bowel preparation prior to pediatric colorectal surgery remains unclear. Although, no organ space infections occurred in the MBP+OA group, suggesting benefit among the most severe SSIs. The overall effectiveness requires more robust investigation.