{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T04:45:39Z","timestamp":1793335539689,"version":"4.5.0"},"reference-count":16,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec id=\"ab-poi240112-4\"><jats:title>Importance<\/jats:title><jats:p>Consensus guidelines from the Infectious Disease Society of America recommend against antimicrobial prophylaxis in the operative management of uncomplicated cholelithiasis; however, these guidelines were derived entirely from the adult surgical population.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240112-5\"><jats:title>Objective<\/jats:title><jats:p>To compare surgical site infection (SSI) outcomes between children undergoing cholecystectomy who received prophylaxis and those who did not.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240112-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This was a cohort study using data from 141 hospitals participating in the National Surgical Quality Improvement Program\u2013Pediatric. Patients younger than 18 years who underwent cholecystectomy for uncomplicated cholelithiasis from January 2021 to December 2022 were identified. Exclusion criteria included diagnoses of acute cholecystitis, pancreatitis, choledocholithiasis, hematologic disorders, and emergent procedures.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240112-7\"><jats:title>Exposure<\/jats:title><jats:p>Administration of prophylactic antibiotics before incision.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240112-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The main outcomes were 30-day postoperative SSI and readmission. Propensity score weighting on the likelihood of receiving prophylaxis was used to balance groups on case acuity, duration of surgery, hospital discharge diagnosis, and patient characteristics. The association between outcomes and the use of prophylaxis was estimated using logistic regression models, weighted by the inverse probability of treatment with a random effect by hospital to control for hospital-level clustering. A secondary analysis was performed exploring the association between broad-spectrum prophylaxis and outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240112-9\"><jats:title>Results<\/jats:title><jats:p>Of 2234 children who met criteria for inclusion (median age, 15.3 years; 19.7% male [399 of 2025]), 2025 (90.6%) received prophylaxis (utilization rates ranged from 0% to 100% among hospitals). Cefazolin was the most commonly used antibiotic (69.2% [1401 of 2025]), and 559 of 2025 patients (27.6%) received extended-spectrum prophylaxis (compared with cefazolin). In the propensity-weighted cohort, SSI rates were lower for children who received prophylaxis compared with those who did not (18.0 of 2016 [0.9%] vs 7.8 of 212 [3.7%]; adjusted odds ratio [AOR], 0.28; 95% CI, 0.11-0.70), and rates were similar between children receiving cefazolin and those receiving more extended-spectrum antibiotics in a secondary propensity-weighted analysis (13.9 of 1399 [1.0%] vs 2.9 of 558 [0.5%]; AOR, 0.54; 95% CI, 0.15-1.95).<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240112-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The results of this study support prophylaxis use for children undergoing nonemergent cholecystectomy; however, use of extended-spectrum antibiotics was not associated with superior outcomes compared with cefazolin alone. Opportunities to optimize infection prevention or antimicrobial stewardship were identified in more than one-third of all children undergoing cholecystectomy.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.6391","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T16:33:26Z","timestamp":1740414806000},"page":"447","source":"Crossref","is-referenced-by-count":6,"title":["Antimicrobial Prophylaxis Use and Outcomes for Children Undergoing Cholecystectomy"],"prefix":"10.1001","volume":"179","author":[{"given":"Kerri A.","family":"McKie","sequence":"first","affiliation":[{"name":"Department of Surgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anoosha","family":"Moturu","sequence":"additional","affiliation":[{"name":"Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionne A.","family":"Graham","sequence":"additional","affiliation":[{"name":"Program for Patient Safety and Quality, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melvin","family":"Coleman","sequence":"additional","affiliation":[{"name":"Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reiping","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Grant","sequence":"additional","affiliation":[{"name":"Children\u2019s Surgery Program Manager, CQI, American College of Surgeons, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline M.","family":"Saito","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Children\u2019s National Hospital, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce L.","family":"Hall","sequence":"additional","affiliation":[{"name":"Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois"},{"name":"University of California, Davis Health System, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Cina","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason G.","family":"Newland","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Nationwide Children's Hospital, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford","family":"Ko","sequence":"additional","affiliation":[{"name":"Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn J.","family":"Rangel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"10014","key":"poi240112r3","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/S0140-6736(15)00473-0","article-title":"Understanding the mechanisms and drivers of antimicrobial resistance.","volume":"387","author":"Holmes","year":"2016","journal-title":"Lancet"},{"issue":"4","key":"poi240112r4","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1089\/sur.2021.207","article-title":"Surgical Infection 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meta-analysis.","volume":"35","author":"Yang","year":"2021","journal-title":"Surg Endosc"},{"issue":"3","key":"poi240112r16","doi-asserted-by":"publisher","first-page":"231","DOI":"10.14701\/ahbps.2018.22.3.231","article-title":"Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a systematic review and meta-analysis.","volume":"22","author":"Kim","year":"2018","journal-title":"Ann Hepatobiliary Pancreat Surg"},{"key":"poi240112r1"},{"key":"poi240112r5"},{"key":"poi240112r2","unstructured":"Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the US 2019. US Dept of Health and Human Services. December 2019. Accessed May 15, 2024. https:\/\/www.cdc.gov\/antimicrobial-resistance\/media\/pdfs\/2019-ar-threats-report-508.pdf?CDC_AAref_Val=https:\/\/www.cdc.gov\/drugresistance\/pdf\/threats-report\/2019-ar-threats-report-508.pdf"},{"key":"poi240112r6","unstructured":"User Guide for the 2022 ACS NSQIP Pediatric Surgical Antibiotic Prophylaxis Participant Use Data File (SAP PUF). American College of Surgeons (ACS). October 2023. Accessed January 16, 2025. https:\/\/www.facs.org\/media\/fk2bdw1u\/peds_nsqip_sap_sar_userguide_2022.pdf"},{"key":"poi240112r7","unstructured":"User Guide for the 2022 ACS NSQIP Pediatric Participant Use Data File (PUF). American College of Surgeons (ACS). October 2023. 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