Prophylactic Antibiotic use and Outcomes in Infants Undergoing Pyloromyotomy: A Multicenter Propensity Matched Cohort Analysis.

Abstract

To compare outcomes in infants undergoing pyloromyotomy who did and did not receive antimicrobial prophylaxis. Variation exists among pediatric surgeons in the perceived utility and use of prophylactic antibiotics for infants undergoing pyloromyotomy. We conducted a multicenter study of infants undergoing pyloromyotomy at 148 hospitals participating in NSQIP-Pediatric from January 2021 to December 2023. Outcomes were compared using patient-level propensity-matched mixed-effects models, adjusting for hospital clustering. A complementary hospital-level analysis assessed the correlation between institutional prophylaxis rates and observed-to-expected (O/E) surgical site infection (SSI) rate ratios. 6093 infants were included, of which 46.6% received prophylaxis. In the propensity-matched analysis, outcomes were similar for SSI (no prophylaxis: 38/2591 [1.6%] vs. prophylaxis: 28/2591 [1.1%], aOR 0.61; 95% CI, 0.37-1.01) and higher rates of prophylaxis use were not correlated with lower SSI O/E rate ratios in the hospital-level analysis (Spearman ρ = 0.11; P = 0.13). In propensity-matched subgroup analyses stratified by operative approach, no benefit was observed in the use of prophylaxis in infants undergoing laparoscopic pyloromyotomy (prophylaxis: 24/2288 [1.1%] vs. no prophylaxis: 25/2288 [1.1%]; aOR, 0.96; 95% CI, 0.55-1.69); however, a significant reduction in SSI rates was observed with open repair (prophylaxis: 6/311 [1.9%] vs. no prophylaxis: 16/311 [5.1%]; aOR 0.36; 95% CI, 0.14-0.93). Routine prophylaxis use does not reduce SSI rates in infants undergoing laparoscopic pyloromyotomy; however, a significant reduction in SSI was observed in infants undergoing open repair, suggesting selective prophylaxis is indicated in this higher-risk cohort.