Omission of Surgical Antibiotic Regimens in Pediatric Urology Publications: A Systematic Review
Elizabeth Snyder, MD, Charan Mohan, BS, Jamie Michael, BS, Sherry Ross, MD.
University of North Carolina, Chapel Hill, NC, USA.
BACKGROUND: Infections after pediatric urology surgeries are a known postoperative complication. However, perioperative and postoperative antibiotic practices are highly variable, and diverse expert opinions exist regarding antibiotic usage for reduction of infection risk given a lack of evidence-based guidelines. We evaluated the literature on common pediatric urology procedures to investigate when and how authors report antibiotic usage and its relation to infectious outcomes.
METHODS: Embase and Medline were queried with systematic medical subject heading terms to identify publications on common pediatric urology surgeries, including the specific urologic surgery type and the reporting of antibiotics or infection. The urologic procedures studied were hypospadias repair, pyeloplasty, orchidopexy performed by a urologist, ureteral reimplant, and circumcision. For circumcision, additional search parameters specified that the procedure was performed by a urologist on an infant older than 30 days. Original research studies for each surgery of interest underwent an abstract screening and subsequent full text screening by two independent reviewers based on predetermined exclusion and inclusion criteria. The selected articles were then evaluated to determine patient demographics, surgical technique used, infection rate reported as an outcome, and any reporting of preoperative or postoperative antibiotics.
RESULTS: We identified 1472 publications, of which 297 met inclusion criteria. Of these, 9% explicitly reported their use of preoperative antibiotics, and 34% reported their use of postoperative antibiotics. Only 6% of studies reported the specific antibiotic class, 15% reported duration of antibiotics, and 1% reported antibiotics dosage. In contrast, 56% of the studies reported infection as an outcome. Of these studies that included their postoperative infection rates, 43% did not mention their antibiotics practices.
CONCLUSIONS: Explicit reporting of surgical antibiotic practices and infection outcomes are infrequently included in studies of pediatric urology procedures, limiting the data that is available for development of evidence-based antibiotics guidelines in this population. Routine incorporation of antibiotic regimens and infection outcomes in pediatric urology studies will increase our ability to better understand the need for antibiotics and to develop standardized evidence-based practices. The additional burden will be minimal for the pediatric urologist performing the procedure or on the authors designing the study as this does not require a change in practice at this time but simply consistent documentation within publications of what antibiotics were utilized and what infectious outcomes were observed. Future studies will benefit from improved reporting on these two factors and allow for objective evaluation of which antibiotic practices result in reduced infection rates.
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