Surgical antibiotic prophylaxis in pediatric urology: Are we following the AUA guidelines? A multi-center evaluation of compliance and impact on morbidity.

Authors

Sri Saran Manivasagam, Jennifer A Kane, Paul Smith, Thomas M FitzGibbon

Published in

Journal of pediatric urology. Pages 106203. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

The American Urological Association (AUA) provides guidance on surgical antibiotic prophylaxis (SAP) for urologic procedures. In the absence of pediatric-specific recommendations, these guidelines are often extrapolated to children. We evaluated national compliance with SAP components (administration, antibiotic choice, timing, and re-dosing) across pediatric urologic procedures and examined associations with postoperative outcomes.
Using the ACS NSQIP-Pediatrics database (2021-2023), we analyzed five procedure categories: hypospadias/urethroplasty, endourologic stone procedures, renal/bladder surgery, cystoscopy, and inguinal/scrotal cases. Compliance was defined per best practice statement on urologic procedures and antimicrobial prophylaxis (2019). Outcomes included infectious complications, readmissions, and reoperations. Multivariable logistic regression adjusted for demographic, clinical, and procedural covariates.
Among 25,058 procedures in which SAP is indicated, complete compliance was 75.8% for hypospadias/urethroplasty, 79.6% for endourologic stone procedures, and 76.4% for renal/bladder surgery. Non-compliance was associated with increased wound dehiscence (2.1% vs 1.4%, p = 0.046) and urinary tract infections (1.3% vs 0.7%, p = 0.036) after hypospadias repair, higher superficial infections (1.2% vs 0.7%, p = 0.009) and readmissions (5.7% vs 4.9%, p = 0.047) after renal/bladder surgery, and lower readmissions (3.3% vs 2.6%, p = 0.011) and reoperations (0.9% vs 0.7%, p = 0.003) with SAP during cystoscopy. On multivariate logistic regression analysis, SAP use was not associated with reduced post-operative morbidity.
National compliance with SAP is generally high but variable across components and procedures. Given inconsistent associations with outcomes and recognized risks of unnecessary antibiotic exposure, pediatric-specific, evidence-based SAP recommendations and stewardship frameworks are warranted.

PMID:
42697771
Bibliographic data and abstract were imported from PubMed on 05 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.