title: Use of mechanical bowel preparation and oral antibiotics for elective colorectal procedures in children: is current practice evidence-based?
abstract: OBJECTIVE
  It is well established through randomized trials that oral antibiotics given with or without a mechanical bowel preparation (MBP) prior to colorectal procedures reduce complications, while MBP given alone provides no benefit. We aimed to characterize trends surrounding bowel preparation in children and determine whether contemporary practice is evidence-based.
  
  
  METHODS
  Retrospective analysis of patients undergoing colorectal procedures at 42 children's hospitals (1/2/2007-12/31/2011) was performed. Patients were analyzed for diagnosis, pre-admission status, and inpatient bowel preparation. Bowel preparation was considered evidence-based if oral antibiotics were utilized with or without a MBP.
  
  
  RESULTS
  49% of all patients were pre-admitted (n=5,473), and the most common diagnoses were anorectal malformations (55%), inflammatory bowel disease (26%), and Hirschsprung's Disease (19%). The most common preparation approaches were MBP alone (54.3%), MBP+oral antibiotics (18.8%), and oral antibiotics alone (4.2%), although significant variation was found in hospital-specific rates for each approach (MBP alone: 0-96.1%, MBP+oral antibiotics: 0-83.6%, orals alone: 0-91.6%, p<0.0001). Only 22.9% of all patients received an evidence-based preparation (range by hospital: 0-92.3%, p<0.0001), and this rate decreased significantly during the five-year study period (27.6% in 2007 vs. 17.3% in 2011, p<0.0001).
  
  
  CONCLUSIONS
  According to the best available clinical evidence, less than a quarter of all children pre-admitted for elective colorectal procedures receive a bowel preparation proven to reduce infectious complications.
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Elliot C
authors.initials: EC
authors.lastname: Pennington
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Christina
authors.initials: C
authors.lastname: Feng
authors.affiliation: Children's Mercy Hospitals & Clinics, Kansas City, Missouri.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Saleem
authors.initials: S
authors.lastname: Islam
authors.affiliation: Seattle Children's Hospital, Seattle, Washington.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: Shawn.Rangel@childrens.harvard.edu.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003107:Colorectal Surgery / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D004733:Enema / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Mechanical bowel preparation; Non-absorbable oral antibioticsl colorectal surgery