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. 2022 Feb 23;11(3):296.
doi: 10.3390/antibiotics11030296.

Antimicrobial Prophylaxis for Urologic Procedures in Paediatric Patients: A RAND/UCLA Appropriateness Method Consensus Study in Italy

Susanna Esposito  1 , Erika Rigotti  2 , Alberto Argentiero  1 , Caterina Caminiti  3 , Elio Castagnola  4 , Laura Lancella  5 , Elisabetta Venturini  6 , Maia De Luca  7 , Stefania La Grutta  8 , Mario Lima  9 , Simonetta Tesoro  10 , Matilde Ciccia  11 , Annamaria Staiano  12 , Giovanni Autore  1 , Giorgio Piacentini  2 , Nicola Principi  13 , The Peri-Operative Prophylaxis In Neonatal And Paediatric Age Pop-NeoPed Study Group
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Antimicrobial Prophylaxis for Urologic Procedures in Paediatric Patients: A RAND/UCLA Appropriateness Method Consensus Study in Italy

Susanna Esposito et al. Antibiotics (Basel). .

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.

Keywords: RAND/UCLA method; cystoscopy; hypospadias; kidney transplantation; nephrolithiasis; surgical antimicrobial prophylaxis; urology.

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Conflict of interest statement

The authors declare no conflict of interest.

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References

    1. Hoen L.A., Bogaert G., Radmayr C., Dogan H.S., Nijman R.J.M., Quaedackers J., Rawashdeh Y.F., Silay M.S., Tekgul S., Bhatt N.R., et al. Update of the EAU/ESPU guidelines on urinary tract infections in children. J. Pediatr. Urol. 2021;17:200–207. doi: 10.1016/j.jpurol.2021.01.037. - DOI - PubMed
    1. Davuluri M., Bernstein A.P., Fram E., Watts K.L. Variations in Perioperative Antibiotic Prescriptions Among Academic Urologists After Ambulatory Endoscopic Urologic Surgery: Impact on Infection Rates and Validation of 2019 Best Practice Statement. Urology. 2020;146:101–106. doi: 10.1016/j.urology.2020.07.049. - DOI - PubMed
    1. Dropkin B.M., Dallmer J.D., Chisholm L.P., Johnsen N.V., Dmochowski R.R., Milam D.F., Kaufman M.R. Are postoperative antibiotics necessary after artificial urinary sphincter insertion? Can. J. Urol. 2020;27:10437–10442. - PubMed
    1. Cai T., Verze P., Brugnolli A., Tiscione D., Luciani L.G., Eccher C., Lanzafame P., Malossini G., Wagenlehner F.M., Mirone V., et al. Adherence to European Association of Urology Guidelines on Prophylactic Antibiotics: An Important Step in Antimicrobial Stewardship. Eur. Urol. 2016;69:276–283. doi: 10.1016/j.eururo.2015.05.010. - DOI - PubMed
    1. Gregg J.R., Bhalla R.G., Cook J.P., Kang C., Dmochowski R., Talbot T.R., Barocas D.A. An Evidence-Based Protocol for Antibiotic Use Prior to Cystoscopy Decreases Antibiotic Use without Impacting Post-Procedural Symptomatic Urinary Tract Infection Rates. J. Urol. 2018;199:1004–1010. doi: 10.1016/j.juro.2017.10.038. - DOI - PubMed

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