Canon Stephen J, Smith Jacob C, Sullivan Elizabeth, Patel Ashay, Zamilpa Ismael
Arkansas Children's Hospital, 1 Children's Way Slot 840, Little Rock, AR, 72202, USA.
Baylor Scott and White-Temple, 2401 S. 31st St, Temple, TX, 76508, USA.
J Pediatr Urol. 2021 Apr;17(2):256.e1-256.e5. doi: 10.1016/j.jpurol.2020.11.033. Epub 2020 Nov 30.
There is limited evidence that prophylactic antibiotics prevent surgical site infection in stented, distal hypospadias repair. Our hypothesis is that the use of prophylactic antibiotics does not affect the rate of surgical site infection in this setting.
We conducted a retrospective study of consecutive patients over a 6-year period with distal penile hypospadias treated with urethral stenting. Variables analyzed include age, type of repair, usage of preoperative and/or postoperative antibiotics, and length of follow-up. Patients with a history of proximal or re-operative hypospadias repair were excluded. Surgical site infection was defined by the presence of postoperative penile erythema and/or purulent drainage treated with therapeutic antibiotics. Secondary outcome analysis included the presence of other hypospadias complications.
441 consecutive subjects met our inclusion criteria with a mean age of 13.3 months. Patients were categorized into groups: Group 1 - Preoperative antibiotics (n = 64), Group 2 - Both Preoperative & Postoperative antibiotics (n = 159), Group 3 - Postoperative antibiotics (n = 122), Group 4 - No Preoperative or Postoperative antibiotics (n = 96). Two surgical site infections were reported out of the 441 patients: 1 in Group 3 and 1 in Group 4 (p = 0.513). There was no significant difference in the total patients with a hypospadias complication between groups. In the table below, Groups 1-3 were combined (345 patients) for comparison to Group 4 (No antibiotics, 96 patients) for further analysis with no difference in SSIs (p = 0.388) or respective hypospadias complications.
The use of perioperative prophylactic antibiotics, both before and after surgery for distal, stented hypospadias repair, have not been shown to reduce the rate of surgical site infections nor hypospadias complications. Consequently, the benefit of prophylactic antibiotics in this setting is unclear.
关于预防性抗生素能否预防带支架的远端尿道下裂修复手术部位感染的证据有限。我们的假设是，在这种情况下使用预防性抗生素不会影响手术部位感染率。
我们对连续6年接受尿道支架治疗的远端阴茎型尿道下裂患者进行了一项回顾性研究。分析的变量包括年龄、修复类型、术前和/或术后抗生素的使用情况以及随访时间。有近端尿道下裂修复史或再次手术史的患者被排除。手术部位感染定义为术后阴茎出现红斑和/或有脓性引流，并接受了治疗性抗生素治疗。次要结局分析包括其他尿道下裂并发症的存在情况。
441名连续受试者符合我们的纳入标准，平均年龄为13.3个月。患者被分为几组：第1组 - 术前使用抗生素（n = 64），第2组 - 术前和术后均使用抗生素（n = 159），第3组 - 术后使用抗生素（n = 122），第4组 - 术前和术后均未使用抗生素（n = 96）。441例患者中报告了2例手术部位感染：第3组1例，第4组1例（p = 0.513）。各组间尿道下裂并发症患者总数无显著差异。在下表中，将第1 - 3组合并（345例患者）与第4组（未使用抗生素，96例患者）进行比较，以进行进一步分析，手术部位感染（p = 0.388）或各自的尿道下裂并发症方面无差异。
对于远端带支架的尿道下裂修复手术，术前和术后使用围手术期预防性抗生素均未显示能降低手术部位感染率或尿道下裂并发症。因此，在这种情况下预防性抗生素的益处尚不清楚。
