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Optimizing antibiotic management for patients with acute appendicitis: A quality improvement study

Jason Beckermann1, Maria E Linnaus1, Hayden Swartz2

  • 1General and Trauma Surgery, Mayo Clinic Health System-Northwest Wisconsin region, Eau Claire, WI.

Surgery
|February 27, 2024
PubMed
Abstract

Insights

This study reduced piperacillin-tazobactam use for appendicitis by updating antibiotic orders and educating clinicians. Surgical site infection rates remained stable, demonstrating a successful quality improvement intervention.

Area of Science:

  • Infectious Diseases
  • Surgical Infections
  • Quality Improvement

Background:

  • Preoperative broad-spectrum antibiotics are standard for appendectomy but face scrutiny due to rising antibiotic resistance.
  • The use of piperacillin-tazobactam for acute appendicitis is a particular concern.
  • Developing strategies to optimize antibiotic use is crucial for patient outcomes and antimicrobial stewardship.

Purpose of the Study:

  • To decrease the use of piperacillin-tazobactam in uncomplicated acute appendicitis.
  • To maintain or decrease surgical site infection (SSI) rates following appendectomy.
  • To implement a quality improvement project focused on appropriate antibiotic selection.

Main Methods:

  • A multisite quality improvement project was conducted.
  • Intervention components included updating electronic health record orders and clinician education on antibiotic selection.
  • Outcomes were compared between the 6-month preintervention and 6-month postintervention periods.

Main Results:

  • Piperacillin-tazobactam use decreased significantly from 51.4% to 20.1% postintervention (P < .001).
  • Surgical site infection rates (superficial, deep, organ space) did not increase.
  • Rates of 30-day readmission, reoperation, and Clostridioides difficile infection remained similar between groups.

Conclusions:

  • The quality improvement intervention effectively reduced piperacillin-tazobactam administration for acute appendicitis.
  • This approach successfully lowered targeted antibiotic use without compromising surgical site infection rates.
  • The findings support optimizing antibiotic selection in appendicitis management to combat resistance.

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