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

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.