Postoperative continuation of antibiotic prophylaxis beyond 24 h is unnecessary for abdominal surgeries in children and neonates

• What is currently known about this topic?: The duration of perioperative antimicrobial prophylaxis (PAMP) for postoperative surgical site infections (SSI) in abdominal surgery should be minimized to prevent the emergence of resistant organisms. Recently, guidelines have been proposed for the appropriate duration of PAMP administration for various surgical procedures. However, there are few detailed reports on the optimal duration of PAMP administration in pediatric abdominal surgery. The type of PAMP administered and the duration of administration varied significantly among institutions. • What new information is contained in this article?: For the surgical procedures for intestinal atresia, congenital biliary dilatation, and stoma closure, shortening the duration of PAMP administration to ≤24 h did not increase the incidence of SSIs. Therefore, PAMP administration could be safely terminated within 24 h postoperatively in the 3 surgical procedures studied. Notably, the administration of a single dose of PAMP within 60 min before the skin incision proved sufficient to prevent SSIs during surgery for congenital intestinal atresia via an umbilical incision. Despite recent WHO recommendations, antibiotic prophylaxis is routinely continued for several days after surgery. We conducted a retrospective study to evaluate the safety and efficacy of antibiotic prophylaxis cessation within 24 h after abdominal surgeries We retrospectively reviewed the charts of patients who underwent 3 representative gastrointestinal surgeries (1; transumbilical small bowel procedure for intestinal atresia or stenosis, 2; extrahepatic bile duct resection, and hepaticojejunostomy for congenital biliary dilatation, 3; stoma closure for intestinal perforation, anorectal malformation, or inflammatory bowel disease) at our institution between 2011 and 2023. The demographic data collected included age, preoperative hemoglobin level, albumin level, body mass index, and ASA class. Intraoperative and postoperative data were also collected. The patients were divided into 2 groups according to the duration of perioperative antibiotics (‘within 24 h’ and ‘beyond 24 h’), and the incidence of superficial incisional SSI (siSSI) was compared between the 2 groups in each procedure During the study period, 25 cases underwent transumbilical small bowel procedure, 23 cases underwent hepaticojejunostomy, and 45 cases underwent stoma closure. The preoperative care bundle including bowel preparation, cleansing, and operative procedures has not changed during the study period. First- and third-generation cephalosporins were administered to all the patients. All patients received their first single dose of antibiotics within 60 min before the skin incision. In particular, 14 patients who underwent small-bowel procedures received only a single dose. The SSI rates for small bowel procedures, hepaticojejunostomy, and stoma closure were 0%, 4.4%, and 4.4%, respectively. No SSIs were observed in any of the procedures in the 'within 24 h' group Based on our study, we conclude that ≤24 h of postoperative continuation of antibiotic prophylaxis is sufficient for siSSI prevention in hepaticojejunostomy and stoma closure. Additionally, single-dose antibiotic prophylaxis is adequate for neonatal small bowel procedures.