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Reducing Piperacillin and Tazobactam Use for Pediatric Perforated Appendicitis

Talal B Seddik1, Lauren A Rabsatt2, Claudia Mueller3

  • 1Pediatric Infectious Diseases, Stanford University School of Medicine, Stanford, California.

The Journal of Surgical Research
|December 19, 2020
PubMed

Insights

An intervention successfully reduced piperacillin and tazobactam (PT) use in pediatric perforated appendicitis. This change did not affect clinical outcomes, demonstrating a safe approach to antibiotic stewardship.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Antibiotic Stewardship

Background:

  • Perforated appendicitis often leads to infectious complications, but optimal antibiotic selection remains debated.
  • Piperacillin and tazobactam (PT) is a broad-spectrum antibiotic frequently used in such cases.
  • There is a need to evaluate strategies for reducing PT use while maintaining patient safety.

Purpose of the Study:

  • To assess the effectiveness and safety of an intervention aimed at decreasing piperacillin and tazobactam (PT) use in pediatric acute perforated appendicitis.
  • To evaluate the impact of provider education and electronic order modification on PT utilization.

Main Methods:

  • A single-center, retrospective cohort study included children (≤18 years) undergoing appendectomy for perforated appendicitis.
  • An intervention involved provider education followed by electronic antibiotic order modification to default to ceftriaxone and metronidazole.
  • Preintervention and postintervention PT exposure and clinical outcomes were compared.

Main Results:

  • Piperacillin and tazobactam (PT) exposure decreased significantly from 78% to 18% post-intervention (P < 0.001).
  • Use of PT for at least half of intravenous antibiotic days also dropped significantly from 78% to 13% (P < 0.001).
  • No significant differences were observed in antibiotic duration, length of stay, surgical site infection rates, or 30-day readmission rates.

Conclusions:

  • Provider education and electronic antibiotic order changes effectively reduced piperacillin and tazobactam (PT) use in pediatric perforated appendicitis.
  • The intervention was safe, as evidenced by the lack of negative impact on key clinical outcomes.
  • This study supports targeted interventions for antibiotic stewardship in pediatric surgical infections.
Abstract

Keywords:
Antimicrobial stewardshipClinical educationOrder setPediatric appendicitisPerforated appendicitisPiperacillin and tazobactam

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