Current practice in perioperative antibiotic prophylaxis for clean surgical procedures among pediatric urologists.

INTRODUCTION

Surgical site infections (SSIs) are rare but important complications in pediatric urologic surgery. While surgical antibiotic prophylaxis (SAP) has led to a decrease in SSIs, it may be unnecessary for Class I/Clean surgical cases. In 2019 the American Urological Association (AUA) Best Practice Statements (BPS) on urologic procedures and antimicrobial prophylaxis were updated advising that routine antimicrobial prophylaxis for Class I cases may not be necessary. The objectives of this study were to evaluate current practices regarding SAP for Class I procedures among pediatric urologists and to assess the impact of the 2019 AUA BPS update on clinical practice.

METHODS

An anonymous cross-sectional survey was distributed via email to Societies for Pediatric Urology (SPU) members. Data collected from the survey included provider demographics, factors influencing antibiotic use, procedure-specific practices, awareness of the 2019 AUA BPS update, and any subsequent changes to individual practices.

RESULTS

A total of 85 of 388 (22 %) SPU members completed the survey. The use of prophylactic antibiotics varied by procedure, with the highest reported use for laparoscopic surgeries (39-48 %) and testicular torsion exploration (39 %), and lowest use for meatotomy and circumcision (3 %). While 79 % of respondents were aware of the 2019 AUA BPS update, only 37 % of those aware modified their practice accordingly. National guidelines, personal experience, and Tanner stage were the most frequently cited factors influencing practice patterns among respondents. Additionally, 21 % of respondents believed even a single dose of antimicrobial prophylaxis contributes to antibiotic resistance.

CONCLUSION

Despite broad awareness of the 2019 AUA BPS update, SAP practice patterns remain variable among pediatric urologists. Further efforts and research are needed to promote evidence-based antimicrobial stewardship in the field of pediatric urology.