Prophylactic Antibiotic use and Outcomes in Infants Undergoing Pyloromyotomy

Objective: To compare outcomes in infants undergoing pyloromyotomy who did and did not receive antimicrobial prophylaxis. Summary Background Data: Variation exists among pediatric surgeons in the perceived utility and use of prophylactic antibiotics for infants undergoing pyloromyotomy. Methods: We conducted a multicenter study of infants undergoing pyloromyotomy at 148 hospitals participating in NSQIP-Pediatric from January 2021 to December 2023. Outcomes were compared using patient-level propensity-matched mixed-effects models, adjusting for hospital clustering. A complementary hospital-level analysis assessed the correlation between institutional prophylaxis rates and observed-to-expected (O/E) surgical site infection (SSI) rate ratios. Results: 6093 infants were included, of which 46.6% received prophylaxis. In the propensity-matched analysis, outcomes were similar for SSI (no prophylaxis: 38/2591 [1.6%] vs. prophylaxis: 28/2591 [1.1%], aOR 0.61; 95% CI, 0.37–1.01) and higher rates of prophylaxis use were not correlated with lower SSI O/E rate ratios in the hospital-level analysis (Spearman ρ = 0.11; P = 0.13). In propensity-matched subgroup analyses stratified by operative approach, no benefit was observed in the use of prophylaxis in infants undergoing laparoscopic pyloromyotomy (prophylaxis: 24/2288 [1.1%] vs. no prophylaxis: 25/2288 [1.1%]; aOR, 0.96; 95% CI, 0.55–1.69); however, a significant reduction in SSI rates was observed with open repair (prophylaxis: 6/311 [1.9%] vs. no prophylaxis: 16/311 [5.1%]; aOR 0.36; 95% CI, 0.14–0.93). Conclusions: Routine prophylaxis use does not reduce SSI rates in infants undergoing laparoscopic pyloromyotomy; however, a significant reduction in SSI was observed in infants undergoing open repair, suggesting selective prophylaxis is indicated in this higher-risk cohort.