¿Son suficientes 24 horas? Evaluación de la duración de los antibióticos profilácticos después del cierre de la pared...

While the current American Pediatric Surgical Association (APSA) recommendation is to discontinue prophylactic antibiotics 24 hours after abdominal wall closure in otherwise healthy gastroschisis patients managed with a silo, the evidence supporting this recommendation is limited. We aimed to determine if at our center the odds of infection in cases who received prophylactic antibiotics only up to 24 hours after closure was greater than cases who received longer courses of antibiotics.

We conducted a retrospective review of neonates with gastroschisis managed with a silo at a tertiary care center from 1991 to 2022. Infants were included if they survived to closure. Excluded infants had ischemia, perforation, no documented prophylactic antibiotics, or delayed closure (>30 days). Patients were classified as receiving either a short-course (≤24 hours post-closure) or prolonged-course (>24 hours) of prophylactic antibiotics. The primary outcome was infection within 30 days of closure (e.g. sepsis, wound infection, central line-associated blood stream infection). Logistic regression adjusted for gestational age, birth weight, delivery type, and time to closure was calculated.

Fifty-three neonates were included: 28 received short-course and 25 received prolonged-course antibiotics. Infection occurred in 16/28 (57%) short-course patients and 11/25 (44%) prolonged-course patients. The adjusted odds ratio of infection for prolonged versus short-course antibiotics was 0.82 (95%CI=0.25,2.65, p=0.74).

Discontinuation of prophylactic antibiotics up to 24 hours after closure was not associated with an increased likelihood of infection in our cohort. This finding supports the current APSA recommendation to discontinue prophylactic antibiotics 24 hours after abdominal wall closure in uncomplicated gastroschisis.