Related Experiment Video
Updated: Dec 25, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Effectiveness of a clinical pathway for pediatric complex appendicitis based on antibiotic stewardship principles
Megan E Cunningham1, Huirong Zhu1, Connor T Hoch2
1Texas Children's Hospital, Division of Pediatric Surgery, 6701 Fannin Street, Houston, TX 77030.
Insights
A new complex appendicitis (CA) pathway limiting antibiotics based on clinical signs proved safe and effective. This approach achieved similar outcomes to traditional methods, optimizing resource use in pediatric care.
Area of Science:
- Pediatric Surgery
- Infectious Disease Management
- Healthcare Resource Optimization
Background:
- Complex appendicitis (CA) management traditionally involves extended antibiotic courses.
- There is a need for evidence-based pathways to optimize antibiotic use and healthcare resources.
Purpose of the Study:
- To evaluate outcomes and resource utilization after implementing a novel CA pathway.
- This pathway limits postoperative antibiotics based on clinical parameters.
Main Methods:
- An interrupted time series analysis compared outcomes before and after pathway implementation.
- Included children with intraoperative CA (gangrenous, perforated, or abscess).
- Assessed hospital length of stay, intra-abdominal abscess, and readmission rates.
Main Results:
- No significant differences were observed in postoperative length of stay, intra-abdominal abscess rates (5% vs. 8%), or readmission rates (12% vs. 8%) between pre- and post-intervention periods.
- Post-intervention outcomes were non-inferior to pre-intervention.
- Perforation and perforation with abscess were associated with higher postoperative abscess risk.
Conclusions:
- A CA protocol guided by clinical parameters is safe and effective.
- This pathway achieves comparable intra-abdominal abscess and readmission rates to more resource-intensive regimens.
- The findings support the use of clinical parameters for antibiotic stewardship in pediatric CA.
Purpose:
Outcomes and resource utilization were evaluated after implementing a novel complex appendicitis (CA) pathway limiting postoperative antibiotics based on clinical parameters.
Methods:
Children with intraoperative CA (gangrenous, perforated, or abscess) were treated with intravenous antibiotics postoperatively until clinical criteria were met, without utilizing CBC or oral antibiotics at discharge. An interrupted time series (pre-intervention, transition, post-intervention) was used to assess outcomes. Hospital length of stay (LOS) was analyzed using segmented regression. Intra-abdominal abscess and readmission rates were analyzed using non-inferiority and multivariate logistic regression.
Results:
Five hundred ten children were included with a median age of 10 [IQR7-12] years. There were no differences in postoperative LOS (slope - 0.008; p = 0.855), intra-abdominal abscess rate (5% vs. 8%; p = 0.135), or readmission rate (12% vs. 8%; p = 0.113) across time periods which remained true when adjusting for age, gender, and intraabdominal disease severity. Post-intervention outcomes were not inferior to pre-intervention, abscess rate (p = 0.002), or readmission rate (p < 0.001). Intraoperative findings of perforation (OR9.0; 95% CI1-71; p = 0.044) and perforation with abscess (OR18.2; 95% CI2-36; p = 0.005) were associated with a greater likelihood of postoperative abscess compared to gangrenous appendicitis.
Conclusion:
A CA protocol based on clinical parameters is safe and effective, resulting in similar intra-abdominal abscess and readmission rates compared to more resource-intense regimens.
Level Of Evidence:
III TYPE OF RESEARCH: Interrupted Time Series.
Related Concept Videos
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...