A multicenter cohort study of 2,234 pediatric patients undergoing cholecystectomy found that antibiotic prophylaxis may reduce the risk of surgical-site infections.
In the study, published in JAMA Pediatrics, investigators analyzed data from 141 hospitals participating in the National Surgical Quality Improvement Program–Pediatric (NSQIP-Pediatric). While 90.6% of the pediatric patients received prophylactic antibiotics, most commonly cefazolin (69.2%), 27.6% received extended-spectrum antibiotics. However, no statistically significant difference in surgical-site infections (SSI) or readmission rates was observed between cefazolin and extended-spectrum antibiotics (adjusted odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.15–1.95 for SSI; adjusted OR = 0.90, 95% CI = 0.40–2.03 for readmission).
"Prophylaxis use was associated with a 72% reduction in the [risk] of SSI; however, no difference in outcomes was found between [patients] treated with cefazolin and those treated with extended-spectrum antibiotics," said lead study author Kerri A. McKie, MD, MPH, of the Department of Surgery at the Boston Children’s Hospital and Harvard Medical School, and her colleagues.
The adjusted OR for SSI among patients receiving prophylaxis was 0.28 (95% CI = 0.11–0.70), with a number needed to treat (NNT) of 35.9 to prevent one SSI.
The retrospective cohort study included pediatric patients undergoing nonemergent cholecystectomy for uncomplicated cholelithiasis between January 2021 and December 2022. Exclusion criteria included acute cholecystitis, pancreatitis, choledocholithiasis, hematologic disorders, and emergent procedures. The majority of the patients (90.6%) received prophylactic antibiotics, most commonly cefazolin (69.2%). Among those receiving prophylaxis, 27.6% received extended-spectrum antibiotics.
Prophylaxis was also linked to a lower risk of 30-day readmission (adjusted OR = 0.33, 95% CI = 0.15–0.71). However, no significant advantage was seen with extended-spectrum antibiotics over cefazolin alone.
The study found wide variability in prophylaxis use across hospitals (0% to 100%), with potential opportunities to optimize infection prevention and antimicrobial stewardship in over 33% of pediatric cholecystectomy cases.
Current IDSA and SIS guidelines advise against prophylaxis for uncomplicated cholelithiasis; however, these recommendations are based solely on adult patient data. Given the observed benefit in pediatric patients, further research is needed to determine whether pediatric-specific guidelines should be developed.
While the retrospective design posed had limitations, the use of propensity score weighting and high E-values suggested robustness against unmeasured confounders.
Given these findings, the investigators suggested a potential shift in practice regarding prophylaxis in pediatric patients undergoing cholecystectomy while reinforcing the importance of antimicrobial stewardship.
Full authors' disclosures are available in the study.
