Prophylactic antibiotics in children undergoing cholecystectomy may reduced SSIs risk, suggests research

A new study published in the Journal of American Medical Association found that prophylactic antimicrobial decreased in surgical site infections (SSIs) in children having cholecystectomy. However, extended-spectrum antibiotic use was not required to maximize results in this group of children.

The Infectious Disease Society of America's consensus recommendations, which were developed only from the adult surgical population, advise against the use of antibiotic prophylaxis in the operational treatment of uncomplicated cholelithiasis. Thereby, to examine the surgical site infection (SSI) consequences of children after cholecystectomy who got prophylaxis with those who did not, Kerri McKie and team carried out this study.

Data from 141 institutions taking part in the National Surgical Quality Improvement Program were used in this cohort research. This study identified patients under the age of 18 who had cholecystectomy for simple cholelithiasis between January 2021 and December 2022. Diagnoses of acute cholecystitis, choledocholithiasis, pancreatitis, hematologic diseases, and emergency operations were among the exclusion criteria.

The primary exposure criterion was the use of preventative antibiotics prior to incision. Readmission and 30-day postoperative SSI were the primary endpoints. Groups were balanced based on patient characteristics, hospital discharge diagnosis, length of operation, and case acuity using propensity score weighted on the chance of obtaining prophylaxis. To account for hospital-level clustering, logistic regression models weighted by the inverse likelihood of treatment with a random effect per hospital were used to quantify the relationship between outcomes and prophylactic usage. A secondary study was conducted to investigate the relationship between outcomes and broad-spectrum prophylaxis.

A total of 2025 (90.6%) of the 2234 children who satisfied the inclusion criteria (median age, 15.3 years; 19.7% male [399 of 2025]) were given prophylaxis (hospital use rates varied from 0% to 100%). In comparison to cefazolin, which was the most often used antibiotic (69.2% [1401 of 2025]), 559 of 2025 patients (27.6%) got extended-spectrum prophylaxis.

In a supplementary propensity-weighted analysis, SSI rates were comparable for children getting cefazolin and those receiving more extended-spectrum antibiotics, and SSI rates were lower for children who got prophylaxis than for those who did not in the propensity-weighted group. Overall, despite the use of extended-spectrum antibiotics not being linked to better results, these findings support the use of these medications as a prophylactics for children having nonemergent cholecystectomy. 

Reference:

McKie, K. A., Moturu, A., Graham, D. A., Coleman, M., Huang, R., Grant, C., Saito, J. M., Hall, B. L., Cina, R. A., Newland, J. G., Ko, C., & Rangel, S. J. (2025). Antimicrobial prophylaxis use and outcomes for children undergoing cholecystectomy. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2024.6391