H. Thobani1, M. Khan2, A. Shah4, C. Thorson3, R. Mathew6, B. Chiu1, M. Schwab1, S. Raymond5, S. Islam2, F. Khan1 1Stanford University, Division Of Pediatric Surgery, Palo Alto, CA, USA 2Aga Khan University Medical College, Section Of Pediatric Surgery, Karachi, Sindh, Pakistan 3University Of Miami, Division Of Pediatric And Adolescent Surgery, Miami, FL, USA 4University Of Nebraska College Of Medicine, Division Of Pediatric Surgery, Omaha, NE, USA 5University Of Florida, Division Of Pediatric Surgery, Gainesville, FL, USA 6Stanford University, Division Of Pediatric Infectious Disease, Palo Alto, CA, USA
Introduction: Recommendations for surgical antimicrobial prophylaxis (SAP) in neonates and young infants are largely derived from empirical data on adults and older children. We aimed to analyze the efficacy of common prophylactic antimicrobial regimens for the prevention of surgical site infections (SSI) in a national cohort of surgical neonates and infants to identify an optimal SAP regimen for small bowel and colorectal surgery in this cohort.
Methods: We utilized the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) SAP dataset to review all patients <90 days old who underwent any small bowel or colorectal surgical procedure from 2021-2022. We excluded patients with congenital immunodeficiencies and those receiving antibiotics prior to SAP. Data on clinical characteristics, including type and duration of SAP, was extracted for analysis. Patients were grouped according to the type of prophylaxis received: 1st generation-cephalosporin (G-C) (cefazolin) only, 2nd G-C (cefotetan/cefoxitin) only, 1st/2nd G-C with metronidazole, or piperacillin-tazobactam. Other prophylactic regimens, including those used for penicillin allergies, were excluded due to low frequencies. The primary outcome was any 30-day SSI-related adverse event, which included any superficial, deep or organ-space SSI, wound dehiscence, sepsis or septic shock within 7-days and readmissions or reoperations for wound infection related causes. Multivariable logistic regression was used to analyze the association between antibiotic class and SSI-rate, adjusting for procedure type stratified as colorectal, small bowel or ostomy closure procedure.
Results: A total of 2153 patients met criteria and were included, with a median age of 23 days (IQR: 3-49 days). With regards to procedure types, 64.7% underwent colorectal procedures, 28.0% underwent small bowel procedures and 7.3% underwent ostomy closures. The majority of patients received either a 1st G-C (54.9%) or 2nd G-C (29.4%) only. The overall rate of SSI-related adverse events was 6.1%. Taking 1st G-Cs as the reference category (SSI rate: 4.7%), patients receiving 2nd G-Cs (SSI: 8.4%), a 1st/2nd G-C with Metronidazole (SSI: 7.9%), and Piperacillin/Tazobactam (SSI: 5.4%), had higher rates of SSI (p=0.014). On adjusted regression analysis, 2nd G-Cs were associated with a higher rate of SSI-related adverse events in this patient cohort (aOR=1.53, 95% C.I.=1.02-2.28) [Table].
Conclusion: There is significant variability in the use of SAP for surgical neonates and infants. In this cohort, patients that received 2nd generation cephalosporins for surgical prophylaxis had higher rates of SSI compared to those who received 1st generation cephalosporins.