M. Anapolsky1, V.M. Ringheanu1, J.J. Strubel1, K.M. Sutyak1, N.B. Hebballi1, J.M. Joly1, M. Broussard1, K. Tsao1 1McGovern Medical School at UTHealth Houston, Department Of Pediatric Surgery, Houston, TX, USA
Introduction: Mechanical bowel preparation with preoperative oral antibiotics (MBP+OA) is recommended in adult surgery to reduce surgical site infections (SSI). While there is a paucity of pediatric-specific evidence, many experts agree that adult guidelines should be followed. Implementation in children presents additional significant barriers, such as preadmission with a nasogastric tube (NGT) for administration. Since 2019, MBP+OA has been adopted in our colostomy takedown protocol. In this study, we aim to evaluate the impact of MBP+OA on SSI compared to the previous practice of MBP alone or no bowel preparation (NBP).
Methods: A retrospective study of all non-neonatal intensive care pediatric patients (≤18 years) who underwent elective colostomy takedown between January 2014 and March 2024 was performed. Demographics, past medical history, including risk factors for SSI, primary diagnosis, antibiotic use, bowel preparation, preadmission and NGT placement, operative details, and 30-day postoperative infectious outcomes were collected. The primary outcome was all SSIs, including a composite outcome of superficial SSI, intra-abdominal abscess, and anastomotic leak. Descriptive statistics were used for the entire sample, and Chi-square, Mann-Whitney-U, and logistic regression were used to assess the difference between NBP and MBP+OA.
Results: One-hundred patients were included with a median age of 10.5 months (IQR 7, 14), of which 62% were male. Primary diagnoses included anorectal malformation (82%), Hirschsprung's disease (7%), trauma (4%), colonic perforation (3%), and other (4%). MBP+OA with polyethylene glycol, neomycin, and erythromycin was used in 61% of cases, of which all were preadmitted, and 80% had NGT placed. NBP was used in 30% of patients, 8% received MBP alone, and 1 patient received oral antibiotics alone. Rectal irrigations or enemas were additionally used in 47% of patients. Antibiotics were used within 14 days of the operation in 9% of patients, all patients received prophylactic antibiotics perioperatively, and 42% had continuation after the operation with a median time of 24 hours (IQR 22, 28). The total SSI rate was 19%, with 21% NBP and 20% MBP+OA (Figure 1), showing no difference on univariate comparison (p= 0.91). When adjusting for gender, prior antibiotic use, continued antibiotic use, and rectal irrigations, there was no difference in SSI between MBP+OA and NBP (OR 0.78, 95% CI 0.23-2.63).
Conclusion: MBP+OA, as recommended for reduction in surgical site infection, was implemented in our institution to reduce SSI. However, the SSI rate remained unchanged. Further prospective study is needed to establish the true effect of MBP+OA as well as alternative strategies for SSI reduction.