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Characteristics of acute appendicitis at a tertiary hospital: analyzing the implementation of an antibiotic
M I Sánchez Códez1, I Benavente Fernández2, I Gutiérrez Rosa3
1Pediatric Infectious Disease Department, Puerta del Mar University Hospital, Cádiz (Spain).
Insights
An antimicrobial optimization program (AOPR) improved antibiotic selection for pediatric acute appendicitis. This led to earlier oral treatment conversion without increasing hospital stay or complications.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Clinical Pharmacy
Background:
- Acute appendicitis is the most common surgical emergency in children.
- Limited evidence exists on optimal antibiotic therapy for pediatric appendicitis prophylaxis and treatment.
Purpose of the Study:
- To evaluate the impact of an antimicrobial optimization program (AOPR) on antibiotic therapy for acute appendicitis in children.
- To assess changes in antibiotic selection, treatment duration, and patient outcomes post-AOPR implementation.
Main Methods:
- Retrospective analysis of 206 pediatric patients with acute appendicitis.
- Comparison of antibiotic regimens and clinical outcomes between pre-AOPR (Sept 2017-Mar 2019) and post-AOPR (Apr 2019-Sept 2019) periods.
- Established clinical and laboratory criteria for converting patients from intravenous to oral antibiotic therapy.
Main Results:
- The post-AOPR group showed increased use of dual (ceftriaxone + metronidazole) and single (cefoxitin) therapies, with decreased use of broad-spectrum agents (amoxicillin/clavulanate, piperacillin/tazobactam).
- Conversion to oral antibiotic therapy significantly increased in the post-AOPR period (p=0.03).
- No significant differences in hospital stay or complication rates were observed between the two periods; earlier use of narrower-spectrum oral agents was noted post-AOPR.
Conclusions:
- Implementing an AOPR is recommended for surgical pathologies.
- Tailoring antibiotic protocols to local resistance patterns and microbiological data is crucial.
- Antimicrobial stewardship can optimize treatment for pediatric acute appendicitis.
Introduction:
Acute appendicitis (AA) is the most frequent surgical pathology in pediatrics. However, publications discussing the most adequate antibiotic therapy for AA prophylaxis and treatment in children are limited.
Material And Methods:
A retrospective analysis of patients under 14 years of age hospitalized as a result of AA was carried out. The periods pre- and post- implementation of an antimicrobial optimization program (AOPR) were compared. The pre-AOPR period went from September 2017 to March 2019, while the post-AOPR period went from April 2019 to September 2019.
Results:
206 patients were included, 139 in the pre-AOPR group, and 67 in the post-AOPR group. Dual therapy (ceftriaxone + metronidazole) and single therapy (cefoxitin) were more commonly used in the post-AOPR group (p= 0.0001), with reduced use of amoxicillin + clavulanic acid and piperacillin + tazobactam as an empirical therapy (p= 0.0001). To determine whether conversion to oral therapy was feasible or not, a number of clinical (no fever, sustained transit, adequate tolerance with satisfactory oral pain control) and blood test (a 20-50% CRP decrease from its highest level and a ≤ 12,000/mm3 leukocyte count) criteria were established. This allowed conversion to oral treatment to increase in the post-AOPR period (p=0.03). No differences in terms of hospital stay or complications were found between periods, but narrower spectrum oral antimicrobials were used earlier in the post-AOPR period.
Conclusions:
Implementing an AOPR for surgical pathologies and establishing protocols adapted to the resistance and microbiological profile found at each unit is strongly recommended.
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