Introduction Surgical site infections (SSIs) are a common complication in liver transplant(LT) recipients. Lack of pediatric prophylaxis guidelines results in variation in preventative antibiotic regimens. Methods We performed a retrospective observational study of LT recipients under 18 years using a merged dataset that included data from PHIS and UNOS between 2006 and 2017. The exposure was defined as the antibiotic(s) received within 24 hours of LT; with 6 categories, ranging from narrow (category 1: cefazolin), to broad). The primary outcome was presence or absence of SSI in the index admission. Mixed-effects logistic regression compared the effectiveness of each category relative to category 1 in preventing SSI. Results Of the 2586 LT, 284 (11%) met SSI criteria. SSI rate was higher (16.2%) in the younger sub-cohort compared to older (8.6%), necessitating a stratified analysis. Antibiotics from category 5 were most commonly used. In the younger sub-cohort, the adjusted risk was increased in all categories compared to the reference, most notably in category 3 (OR 2.58; 0.69-9.59) and category 6 (OR 2.76; 0.66-11.56). In the older sub-cohort, estimated ORs were also increased for each category, most notably in category 4 (2.49; 0.99-6.27). None of the ORs suggested benefit from broader-spectrum prophylaxis. Our E value assessment suggests it’s unlikely there is unmeasured confounding by indication to the degree necessary to revert ORs to protective. Conclusion There was wide variation in antibiotic prophylaxis. Adjusted analyses did not reveal a protective benefit of broader-spectrum prophylaxis in either sub-cohort, suggesting that narrower regimens may be adequate.

中文翻译：

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围手术期抗生素治疗方案预防小儿肝移植受者手术部位感染的比较效果

简介 手术部位感染 (SSI) 是肝移植 (LT) 受者的常见并发症。缺乏儿科预防指南导致预防性抗生素治疗方案发生变化。方法 我们使用包含 2006 年至 2017 年间来自 PHIS 和 UNOS 的数据的合并数据集，对 18 岁以下 LT 接受者进行了回顾性观察研究。暴露定义为 LT 后 24 小时内接受的抗生素；有 6 个类别，范围从狭义（类别 1：头孢唑林）到广义）。主要结果是指标入院中是否存在 SSI。混合效应逻辑回归比较了每个类别相对于类别 1 在预防 SSI 方面的有效性。结果 在 2586 名 LT 中，284 名 (11%) 符合 SSI 标准。与年龄较大的亚队列 (8.6%) 相比，年轻亚队列的 SSI 率 (16.2%) 更高，因此需要进行分层分析。最常用的是第 5 类抗生素。在较年轻的子队列中，与参考相比，所有类别的调整后风险均有所增加，最显着的是类别 3（OR 2.58；0.69-9.59）和类别 6（OR 2.76；0.66-11.56）。在较老的子队列中，每个类别的估计 OR 也有所增加，尤其是第 4 类（2.49；0.99-6.27）。没有一个手术室表明可以从更广谱的预防中获益。我们的 E 值评估表明，通过指示将 OR 恢复为保护性所需的程度，不太可能存在无法测量的混杂因素。结论 抗生素预防方面存在很大差异。调整后的分析并未显示出更广谱预防对任一亚组的保护作用，这表明更窄的治疗方案可能就足够了。