Abstract
The main aim of surgical antimicrobial prophylaxis (SAP) in urologic procedures is to prevent bacteraemia, surgical site infections (SSIs), and postoperative urinary tract infections (ppUTIs). Guidelines for SAP in paediatric urology are lacking. Only some aspects of this complex topic have been studied, and the use of antibiotic prophylaxis prior to surgical procedures seems to be more often linked to institutional schools of thought or experts’ opinions than to rules dictated by studies demonstrating the most correct and preferred management. Therefore, the aim of this Consensus document realized using the RAND/UCLA appropriateness method is to provide clinicians with a series of recommendations on SAP for the prevention of bacteraemia, SSIs, and ppUTIs after urologic imaging and surgical procedures in paediatric patients. Despite the few available studies, experts agree on some basilar concepts related to SAP for urologic procedures in paediatric patients. Before any urological procedure is conducted, UTI must be excluded. Clean procedures do not require SAP, with the exception of prosthetic device implantation and groin and perineal incisions where the SSI risk may be increased. In contrast, SAP is needed in clean-contaminated procedures. Studies have also suggested the safety of eliminating SAP in paediatric hernia repair and orchiopexy. To limit the emergence of resistance, every effort to reduce and rationalize antibiotic consumption for SAP must be made. Increased use of antibiotic stewardship can be greatly effective in this regard.
Highlights
The main aim of surgical antimicrobial prophylaxis (SAP) in urologic procedures is to prevent bacteraemia, surgical site infections (SSIs), and postoperative urinary tract infections [1]
This explains why SAP is commonly prescribed to children undergoing retrograde urethrography (RUG), UDS, voiding cystourethrography (VCUG), and radionuclide cystography (RNC) [13]
The results showed that infectious problems even in untreated children are rare and that treatment, regardless of type, does not modify the risk of infections [44]
Summary
The main aim of surgical antimicrobial prophylaxis (SAP) in urologic procedures is to prevent bacteraemia, surgical site infections (SSIs), and postoperative urinary tract infections (ppUTIs) [1]. Different conclusions have been drawn, making it very difficult to decide which could be the most effective and safe antibiotic prescription. This explains why most of the studies carried out to evaluate how antibiotics are used to prevent infections in patients undergoing urological procedures have shown substantial variations in practice patterns among surveyed urologists [4,5,6]. The aim of this Consensus document is to provide clinicians with a series of recommendations on prophylaxis for the prevention of bacteraemia, SSIs, and ppUTIs after urologic imaging and surgical procedures in paediatric patients (0–18 years old). The recommendations are based on a careful review of the available scientific evidence and on the evaluation of a multidisciplinary group of experts regarding the choice of the molecule, dosage, time, and duration of administration for the most common urological surgical procedures
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