Review of Perioperative Prophylactic Antibiotic Use during Laparoscopic Cholecystectomy and Subsequent Surgical Site Infection Development at a Single Children's Hospital

Kayla B. Briggs, James A. Fraser, Wendy Jo Svetanoff, Jessica K. Staszak, Charles L. Snyder, Pablo Aguayo, David Juang, Rebecca M. Rentea, Richard J. Hendrickson, Jason D. Fraser, Shawn D. St Peter, Tolulope A. Oyetunji

Research output: Contribution to journalReview articlepeer-review

Abstract

Objectives With the rise of antibiotic resistance, the use of prophylactic preoperative antibiotics (PPA) has been questioned in cases with low rates of surgical site infection (SSI). We report PPA usage and SSI rates after elective laparoscopic cholecystectomy at our institution. Materials and Methods A retrospective review of children younger than 18 years who underwent elective outpatient laparoscopic cholecystectomy between July 2010 and August 2020 was performed. Demographic, preoperative work-up, antibiotic use, intraoperative characteristics, and SSI data were collected via chart review. SSI was defined as clinical signs of infection that required antibiotics within 30 days of surgery. Results A total of 502 patients met the inclusion criteria; 50% were preoperatively diagnosed with symptomatic cholelithiasis, 47% with biliary dyskinesia, 2% with hyperkinetic gallbladder, and 1% with gallbladder polyp(s). The majority were female (78%) and Caucasian (80%). In total, 60% (n = 301) of patients received PPA, while 40% (n = 201) did not; 1.3% (n = 4) of those who received PPA developed SSI, compared with 5.5% (n = 11) of those who did not receive PPA (p = 0.01). Though PPA use was associated with a 77% reduction in the risk of SSI in multivariate analysis (p = 0.01), all SSIs were superficial. One child required readmission for intravenous antibiotics, while the remainder were treated with outpatient antibiotics. Gender, age, body mass index, ethnicity, and preoperative diagnosis did not influence the likelihood of receiving PPA. Conclusion Given the relatively low morbidity of the superficial SSI, conservative use of PPA is advised to avoid contributing to antibiotic resistance.

Original languageEnglish
Pages (from-to)85-90
Number of pages6
JournalEuropean Journal of Pediatric Surgery
Volume32
Issue number1
DOIs
StatePublished - Feb 1 2022

Keywords

  • antibiotic overuse
  • laparoscopic cholecystectomy
  • pediatric cholecystectomy
  • perioperative antibiotics
  • prophylactic antibiotics

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