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Variation in anti-microbial prescription and complications post emergency appendicectomy in Australia: do we follow
Da Wei Thong1, Jason Kim1, Benjamin Dobson1
1Department of Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
Background:
This study aims to establish compliance levels to prescription guidelines among Australian surgeons in the use of antibiotics in the surgical management of appendicitis. The secondary outcomes are predictors of post-operative infective complications; surgical site infection (SSI) and intra-abdominal abscess (IAA) at 30 days.
Methods:
A multi-centre, prospective, observational study was conducted over a period of 2 months with a 30-day follow-up. Patients were eligible for recruitment if they underwent appendicectomy for suspected appendicitis. Antibiotics prescription practices were recorded and compared to national guidelines.
Results:
A total of 1189 patients were recruited across 27 centres; 1081 (92.1%) patients were given prophylactic antibiotics at the time of appendicectomy. Patients with gangrenous appendicitis were more likely to receive prophylactic antibiotics (98.9%); lower rates of use were seen in the non-appendicitis group (85.7%). A total of 619 (53.3%) patients received antibiotics in the post-operative period. Despite recommendations, 300 (44.3%) patients with simple appendicitis received post-operative antibiotics. Only six (2.9%) patients with complicated appendicitis did not receive antibiotics. Overall, SSI and IAA rates were 1.9% and 2.7%, respectively. Aboriginal and Torres Strait Islanders (P = 0.02) and patients with converted operations (P = 0.001) were more likely to have a SSI. Patients with complicated appendicitis and those operated on by a consultant were more likely to increase the odds of IAA (odds ratio 3.8 and 5.1, respectively).
Conclusion:
This broad-based study shows mixed compliance with antibiotic guidelines in the surgical management of appendicitis in Australia. The use of post-operative antibiotics in patients with simple appendicitis should be a target for antimicrobial stewardship programmes to prevent antibiotic over-utilization.
Insights
Australian surgeons show mixed compliance with antibiotic guidelines for appendicitis. Overuse of post-operative antibiotics in simple appendicitis cases needs antimicrobial stewardship intervention to prevent resistance.
Area of Science:
- Medical research
- Surgical oncology
- Infectious diseases
Background:
- Antibiotic use in appendicitis management is critical but requires adherence to guidelines.
- Compliance with national antibiotic prescription guidelines among Australian surgeons is not well-established.
- Post-operative infective complications, including surgical site infection (SSI) and intra-abdominal abscess (IAA), are significant concerns.
Purpose of the Study:
- To assess compliance levels with antibiotic prescription guidelines in the surgical management of appendicitis among Australian surgeons.
- To identify predictors of post-operative infective complications (SSI and IAA) within 30 days.
- To evaluate antibiotic usage patterns in relation to appendicitis severity and surgical approach.
Main Methods:
- A multi-centre, prospective, observational study was conducted over two months with a 30-day follow-up period.
- 1189 patients undergoing appendicectomy for suspected appendicitis were recruited across 27 Australian centres.
- Antibiotic prescription practices were recorded and compared against national guidelines.
Main Results:
- Prophylactic antibiotics were administered to 92.1% of patients, with higher rates in gangrenous appendicitis (98.9%).
- Post-operative antibiotics were given to 53.3% of patients; notably, 44.3% with simple appendicitis received them, contrary to guidelines.
- Overall SSI and IAA rates were 1.9% and 2.7%, respectively. Aboriginal and Torres Strait Islander status and converted operations predicted SSI; complicated appendicitis and consultant-led surgery predicted IAA.
Conclusions:
- Compliance with antibiotic guidelines in Australian appendicitis surgery is mixed, particularly regarding post-operative use in simple cases.
- Targeted antimicrobial stewardship programs are recommended to address the over-utilization of post-operative antibiotics in simple appendicitis.
- Further research into predictors of post-operative complications can refine antibiotic strategies and improve patient outcomes.
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