Study: Prophylactic antibiotics reduce SSIs in pediatric cholecystectomy

Editor's Note

A cohort study published February 24 in JAMA Pediatrics found that prophylactic antibiotics reduced the odds of surgical site infections (SSIs) by 72% in children undergoing cholecystectomy for uncomplicated cholelithiasis. However, extended-spectrum antibiotics offered no additional benefit over cefazolin, suggesting that simpler prophylaxis protocols could optimize outcomes while supporting antimicrobial stewardship.

The multicenter cohort study analyzed data from 2,234 pediatric patients who underwent cholecystectomy at 141 hospitals between January 2021 and December 2022. Primary outcomes were 30-day postoperative SSI rates and hospital readmission. Key findings include:

• Prophylaxis was associated with a 72% reduction in the odds of SSI (Adjusted Odds Ratio [AOR], 0.28; 95% CI, 0.11-0.70).
• Children receiving prophylaxis had a significantly lower SSI rate (0.9%) compared to those who did not receive prophylaxis (3.7%).
• SSI rates were similar between children who received cefazolin (1.0%) and those who received extended-spectrum antibiotics (0.5%).
• No significant difference in SSI prevention was observed (AOR, 0.54; 95% CI).
• Readmission was lower in children receiving prophylaxis (1.5%) compared to those who did not (4.4%). Overall readmission rate was 1.6%.

These findings support more streamlined prophylaxis practices for pediatric cholecystectomy challenge, authors write, challenging current guidelines based on adult data. The study also underscores the potential for improved antimicrobial stewardship by avoiding unnecessary use of broad-spectrum antibiotics.