Reducing Piperacillin and Tazobactam Use for Pediatric Perforated Appendicitis

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.