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Post-operative antibiotics after appendectomy and post-operative abscess development: a retrospective analysis
Michael J Hughes1, Ewen Harrison, Simon Paterson-Brown
1Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. michaelh@doctors.net.uk
Surgical Infections
|February 23, 2013
Summary
For simple appendicitis, post-operative antibiotics may not be beneficial. In complicated appendicitis, prolonged antibiotics did not reduce intra-abdominal infections, but stopping them early with fever or high white blood cell count increased risk.
Area of Science:
- Surgical infections
- Antibiotic stewardship
- Appendicitis management
Background:
- Appendectomy is a common emergency surgery.
- Post-operative antibiotics are used for prophylaxis against infective complications.
- Optimal antibiotic regimens remain undefined.
Purpose of the Study:
- To assess the relationship between post-operative antibiotic duration and intra-abdominal infections (IAIs) after appendectomy.
Main Methods:
- Retrospective review of 266 appendectomy patients (Sept 2009 - Aug 2010).
- Data collected included appendix appearance, antibiotic use, WBC count, and temperature.
- Intra-abdominal infections (IAIs) were the primary outcome.
Main Results:
- Overall IAI rate was 6.8% (18/266).
- Prolonging antibiotics did not reduce IAI rates in simple or complicated appendicitis.
- In complicated appendicitis, fever or leukocytosis at IV to oral antibiotic switch predicted IAI development (p=0.013).
Conclusions:
- Post-operative antibiotics may not be beneficial for simple appendicitis.
- Extended antibiotic courses did not decrease IAIs in complicated appendicitis.
- Cessation of IV antibiotics during fever or leukocytosis in complicated appendicitis is associated with increased IAI risk.
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