Prophylactic antibiotic in pubertal testicular torsion: Is it Justified?

There is insufficient evidence to support the effectiveness of preoperative antibiotic prophylaxis in reducing surgical site infections (SSI) during urgent testicular torsion (TT) surgeries.

The primary objective was to determine the incidence of SSI in patients undergoing surgery for testicular torsion and to assess the impact of antibiotic prophylaxis on SSI rates.

Retrospective study, including patients with acute scrotum who underwent urgent surgery for clinically confirmed testicular torsion, including orchiectomy, tunica vaginalis flap, and orchiopexy. Exclusion criteria included neonatal or prepubertal testicular torsion, delayed or elective surgical intervention, and lack of follow-up after surgery. Population characteristics were described in patients with and without antibiotic prophylaxis, and a case-control analysis was conducted. Risk ratios and the number needed to prevent SSI were analyzed, along with univariate and multivariate analyses to identify risk factors and assess the effectiveness of antibiotic prophylaxis.

448 patients met the inclusion criteria. The mean age of diagnosis was 14.07 years, with a median pain duration of 8.77 h. Pre-operative prophylactic antibiotics were administered to 75.67 % of patients. The overall prevalence of SSI was 3.12 %. SSIs occurred in 2.36 % of patients in the prophylaxis group versus 5.55 % in the non-prophylaxis group (p = 0.1). The absolute risk reduction with the use of antibiotic prophylaxis was 3.14 %. Univariate analysis identified obesity and experiencing less than 12 h of pain before surgery as potential factors associated with SSI, whereas multivariate analysis found no significant association between the pre-selected variables and SSI.

The study demonstrated a low incidence of SSI following testicular torsion surgery, with no significant difference between patients receiving antibiotic prophylaxis and those who did not. Based on our analysis, there is no demonstrable benefit of administering antibiotic prophylaxis in reducing the risk of surgical site infections (SSI) in this population. While there is clearly no benefit among patients who experienced less than 12 h of pain prior to the operation, we were unable to demonstrate a significant benefit in those with more than 12 h of pain; however, there may be some potential benefit in this subgroup.

Based on our study, there is no demonstrable benefit of administering antibiotic prophylaxis in reducing the overall risk of surgical site infections (SSI) in this population.