Key result
Surgical antibiotic prophylaxis did not significantly reduce the risk of surgical site infection in children undergoing surgery compared to no prophylaxis (OR 1.20; 95% CI 0.91-1.58).
Why the study?
The study was conducted to establish the role of surgical antibiotic prophylaxis in preventing surgical site infections in children undergoing surgery.
Does surgical antibiotic prophylaxis prevent surgical site infection in children undergoing surgery?
Meta-Analysis (n=202,405)
Does surgical antibiotic prophylaxis prevent surgical site infection in children undergoing surgery?
Odds Ratio: 1.2 (95% CI 0.91–1.58)
Surgical antibiotic prophylaxis was not associated with a reduction in surgical site infections in children, highlighting a need for higher quality evidence to guide practice.
Does not support routine prophylaxis in pediatric surgery; leaves open need for higher-quality RCTs to guide practice.
Background: To establish the role of surgical antibiotic prophylaxis (SAP) in the prevention of surgical site infection (SSI) in children undergoing surgery. Design: A systematic review and meta-analysis of six databases: MEDLINE (PubMed), EMBASE, CINAHL Plus, Cochrane Library, Web of Science, and Scopus. Study Selection: Included studies (irrespective of design) compared outcomes in children undergoing surgery, aged 0 to 21 years who received SAP with those who did not, with SSI as an outcome, using the U.S. Centers for Disease Control and Prevention (CDC) definitions for SSI. Data Extraction: Two independent reviewers applied eligibility criteria, assessed the risk of bias, and extracted data. Results: A total of six randomized control trials and 26 observational studies including 202,593 surgical procedures among 202,405 participants were included in the review. The pooled odds ratio of SSI was 1.20; (95% confidence interval [CI], 0.91–1.58) comparing those receiving SAP with those not receiving SAP, with moderate heterogeneity in effect size between studies (τ 2 = 0.246; χ 2 = 69.75; p < 0.001; I 2 = 57.0%). There was insufficient data on many factors known to be associated with SSI, such as cost, length of stay, re-admission, and re-operation; it was therefore not possible to perform subanalyses on these. Conclusions: This review and metanalysis did not find a preventive action of SAP against SSI, and our results suggest that SAP should not be used in surgical wound class (SWC) I procedures in children. However, considering the poor quality of included studies, the principal message of this study is in highlighting the absence of quality data to drive evidence-based decision-making in SSI prevention in children, and in advocating for more research in this field.
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Nthumba et al. (2022) conducted a meta-analysis in children undergoing surgery (n=202,405). Surgical antibiotic prophylaxis vs. no surgical antibiotic prophylaxis was evaluated on surgical site infection (SSI) (OR 1.20, 95% CI 0.91-1.58). Surgical antibiotic prophylaxis did not significantly reduce the risk of surgical site infection in children undergoing surgery compared to no prophylaxis (OR 1.20; 95% CI 0.91-1.58).
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