With the rise of resistant organisms to most commonly used antibiotics, there is a plea for judicious use of antibiotics, especially for clean surgical procedures. Potential adverse events associated with antibiotic use include allergic reaction (including anaphylaxis), clostridium difficile infection, and selecting for resistant bacteria. Surgical site infections (SSI) are very rare in patients undergoing clean paediatric urologic procedures. Current guidelines are unclear about the efficacy of surgical antibiotic prophylaxis for prevention of SSI in the paediatric population. Local policies and surgeon preferences vary widely. The authors of this paper hypothesised that children who received antibiotics prior to orchidopexy would have no reduction in surgical site infection (SSI) risk but an increased risk of antibiotic-associated adverse events. They carried out a retrospective cohort study of all males aged between 30 days and 18 years who underwent an orchidopexy. They found that antibiotic prophylaxis did not reduce the risk of postoperative SSI, readmissions, or hospital visits. Patients who received antibiotics had significantly increased odds of perioperative allergic reaction, thereby demonstrating that the risks of routine use of prophylactic antibiotics outweigh the benefits in children undergoing orchiopexy. 

Is surgical antibiotic prophylaxis necessary for pediatric orchiopexy?
Rensing AJ, Whittam BM, Chan KH, et al.
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Ravindar Anbarasan

Southampton Children’s Hospital.

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