Department of Urology, University of Rochester Medical Center, 601 Elmwood Ave. Rochester, NY 14642, USA.
Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave. Boston, MA 02115, USA.
J Pediatr Urol. 2022 Dec;18(6):759-763. doi: 10.1016/j.jpurol.2022.05.003. Epub 2022 May 13.
Judicious use of antibiotics for surgical prophylaxis is important for reducing antimicrobial resistance while preventing infectious surgical complications. In the setting of pediatric distal hypospadias repairs, it is unclear if antibiotic surgical prophylaxis is beneficial.
The purpose of this study was to compare rates of infectious complications in pediatric subjects undergoing distal hypospadias repair who received any peri-operative antibiotics to those who did not.
This was a review of a retrospective cohort from a database of individuals undergoing hypospadias repairs evaluating whether they received peri-operative or post-operative antibiotic prophylaxis and determining the rate of infectious complications in those who did compared to those who did not receive antibiotic prophylaxis. Infectious complications were defined as surgical site infection (SSI) or urinary tract infection (UTI).
There was no significant difference in infectious complication rates between individuals who received peri-operative parenteral antibiotic prophylaxis and those who did not. All subjects with infectious complications received post-operative oral antibiotic prophylaxis. There was one instance of C. difficile infection in a subject who received peri-operative parenteral antibiotics.
Reducing antibiotic utilization without increasing infectious surgical complications is important in safely reducing antimicrobial resistance. In this study of pediatric distal hypospadias repair, peri-operative antibiotics did not demonstrate a clear benefit and post-operative oral antibiotics demonstrated no benefit in preventing infectious complications. Other studies evaluating peri- and post-operative antibiotics for pediatric hypospadias repair have also failed to demonstrate a benefit for antibiotics in preventing infections. Practitioners should reconsider the use of antibiotics in this setting.
Routine antibiotic prophylaxis does not appear beneficial for preventing infectious complications following uncomplicated, stented pediatric distal hypospadias repairs.
合理使用抗生素进行手术预防是减少抗菌药物耐药性的重要手段，同时可以预防感染性手术并发症。在小儿远端尿道下裂修复术中，抗生素手术预防是否有益尚不清楚。
本研究旨在比较接受或不接受任何围手术期抗生素治疗的小儿远端尿道下裂修复术患者的感染性并发症发生率。
这是对数据库中接受尿道下裂修复术的个体进行的回顾性队列研究，评估他们是否接受围手术期或术后抗生素预防，并确定接受抗生素预防与未接受抗生素预防的患者中感染性并发症的发生率。感染性并发症定义为手术部位感染（SSI）或尿路感染（UTI）。
接受围手术期静脉内抗生素预防的患者与未接受的患者之间，感染性并发症发生率无显著差异。所有发生感染性并发症的患者均接受术后口服抗生素预防。接受围手术期静脉内抗生素的患者中有一例艰难梭菌感染。
在安全减少抗菌药物耐药性的情况下，减少抗生素的使用而不增加感染性手术并发症非常重要。在这项小儿远端尿道下裂修复术的研究中，围手术期抗生素并未显示出明显的益处，术后口服抗生素也未能预防感染性并发症。其他评估小儿尿道下裂修复术围手术期和术后抗生素的研究也未能证明抗生素在预防感染方面的益处。临床医生应重新考虑在该情况下使用抗生素。
对于未并发感染的小儿远端尿道下裂修复术，常规抗生素预防似乎并不能预防感染性并发症。
