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Antibiotic Prophylaxis for Pyloromyotomy in Children: An Opportunity for Better Stewardship

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Abstract

Introduction

Surgical site infection is very uncommon after pyloromyotomy in children, and it is considered a “clean” procedure under the traditional wound classification system. This study aims to investigate prophylactic antibiotic administration for pyloromyotomy among children’s hospitals in the USA.

Methods

The Pediatric Health Information System (PHIS) database was retrospectively reviewed from 2014 to 2015 including all patients less than 1 year old who had a principal diagnosis of pyloric stenosis and underwent pyloromyotomy. Patient demographics, hospital length of stay, and perioperative antibiotic administration were extracted.

Results

A total of 4206 patients met study criteria. Most patients were male (84%) and Caucasian (70%). The median age at admission was 32 days (IQR 24–44 days), and median length of stay was 2 days (IQR 1–2 days). Antibiotics were administered perioperatively in 2153 (51%) patients with marked variation among children’s hospitals. Antibiotics were given to more than 10% of patients in more than 90% of hospitals, and only two of 49 hospitals gave no antibiotic prophylaxis.

Conclusions

This study has shown that at several tertiary-level children’s hospitals in the USA, antibiotic prophylaxis is administered for pyloromyotomy, a “clean” procedure. This highlights the need for standardization of care and more effective antibiotic stewardship in pediatric surgery.

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Acknowledgements

The authors express sincere gratitude to the members of the Pediatric Health Research Outcomes Group for Surgery at Ann & Robert H Lurie Children’s Hospital of Chicago for assistance in data analysis.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20001, USA

    Kibileri Williams

  2. Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611, USA

    Timothy Lautz

  3. Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611, USA

    Timothy Lautz

  4. Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA

    Richard J. Hendrickson & Tolulope A. Oyetunji

Authors
  1. Kibileri Williams
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  2. Timothy Lautz
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  3. Richard J. Hendrickson
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  4. Tolulope A. Oyetunji
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Contributions

KW assisted with data analysis and was the primary author of the manuscript. TL assisted with data analysis and carried out editing of the manuscript. RJH provided final editing of the manuscript. TAO conceptualized the project, performed data analysis, and supervised the preparation of the manuscript.

Corresponding author

Correspondence to Tolulope A. Oyetunji.

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Conflict of interest

The abstract of this manuscript was presented at the International Pediatric Endosurgery Group’s 26th Annual Congress for Endosurgery in Children in London, England, in July 2017. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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Williams, K., Lautz, T., Hendrickson, R.J. et al. Antibiotic Prophylaxis for Pyloromyotomy in Children: An Opportunity for Better Stewardship. World J Surg 42, 4107–4111 (2018). https://doi.org/10.1007/s00268-018-4729-0

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  • DOI: https://doi.org/10.1007/s00268-018-4729-0

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