Is Parenteral Antibiotic Prophylaxis Beneficial for Stented Distal Hypospadias Repair?
David Diamond, MD, Caleb Nelson, MD, MPH, Saafia Masoom, BA, Tanya Logvinenko, PhD, Ozge Yetistirici, MPH, Alyssia Venna, BA.
Boston Children's Hospital, Boston, MA, USA.
There has been heightened scrutiny of surgical antibiotic prophylaxis broadly to minimize bacterial resistance and medical expense. Stented hypospadias repair has traditionally entailed intraoperative parenteral and post-operative oral antibiotic prophylaxis although the evidence supporting either is limited. Prior studies have focused on post-operative oral prophylaxis. We elected to retrospectively investigate the benefit of peri-operative parenteral antibiotic in preventing surgical site and urinary tract infections.
828 patients undergoing stented, distal hypospadias repair were included. 728 received peri-operative parenteral antibiotics (Cephazolin or Clindamycin) whereas 101 patients received no antibiotic. The large majority were TIP repairs, stented from 3-7 days post-operatively. Surgical site and urinary tract infectious complications were sought out in both the antibiotic prophylaxis and no antibiotic groups. In addition, 681 of the 828 patients received post-operative oral antibiotic (Bactrim, Cephalexin, Amoxicillin, Augmentin, Clindamycin,
Nitrofurantoin, Trimethoprim, Cipro) until stent removal, whereas 147 received none.
Logistic regression was used to compare effects of antibiotic use on the infectious complications. Propensity scores for antibiotic use were constructed and accounted for in the main analyses.
Infectious complications included UTI (7), acute cellulitis (3), wound infection (1) and infected inclusion cyst (1) for an overall rate of 1.4% (12/828). Within the no parenteral antibiotic group there was one infectious complication—a UTI (1%, 1/100). Within the parenteral antibiotic prophylaxis group there were 11 infectious complications (1.5%, 11/728). In addition, there was one case of recurrent C. Difficile infection in the parenteral antibiotic treatment group. Our observed infection rates were similar to that expected based on prior literature. After adjusting for the propensity to use parenteral antibiotic prophylaxis, the odds of infectious complications were not different between the parenteral antibiotic and no parenteral antibiotic groups (OR=0.65, p=0.73). In addition, upon investigating the effects of oral antibiotic prophylaxis, we discovered that all 12 patients with an infectious complication had received oral antibiotic.
In this, the largest retrospective study of effectiveness of antibiotic prophylaxis in preventing infectious complications in stented, distal hypospadias repair, we found no advantage to the use of perioperative parenteral antibiotics. Neither did the use of oral antibiotic appear to confer benefit.The case of recurrent C. Difficile in the antibiotic prophylaxis group is a reminder of the potential risks of routine antibiotic usage. It appears that the rate of infectious complications after distal hypospadias repair is exceedingly low regardless of the use of parenteral perioperative antibiotics.
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