Antibiotics and Surgically Treated Acute Appendicitis, When, Where, and Why?

Area of Science:

• Surgical Infection Prevention
• Emergency Medicine
• Antibiotic Stewardship

Background:

• Pre-incisional antibiotics (POA) are standard for clean-contaminated surgery to reduce surgical site infections (SSIs).
• Patients undergoing emergency surgery for intra-abdominal infections often receive emergency department antibiotics (EDA), potentially negating POA benefits.
• This study investigated the efficacy of POA in emergency appendectomy patients already treated with EDA.

Purpose of the Study:

• To determine if pre-incisional cefazolin reduces SSIs in patients undergoing emergency appendectomy.
• To identify factors associated with SSIs in this patient population.

Main Methods:

• Retrospective review of 1380 patients undergoing emergency appendectomy (2013-2020).
• Data abstracted included demographics, appendicitis severity, comorbidities, and antibiotic administration (EDA and POA).
• Logistic regression models assessed the impact of POA and other factors on superficial/deep and organ-space SSIs.

Main Results:

• POA was not predictive of SSI (p=0.632).
• Perforation (OR: 17.08) and male gender (OR: 2.75) were associated with organ-space SSIs; pre-incisional cefazolin was not (OR: 0.83).
• Emergency department broad-spectrum antibiotics (EDA) were associated with lower superficial/deep infection (OR: 0.06), but pre-incisional cefazolin was not (OR: 0.71).

Conclusions:

• Additional pre-incisional cefazolin does not reduce SSIs in emergency appendectomy patients who have received EDA.
• Focusing on timely EDA and managing factors like perforation and gender may be more critical for SSI prevention in this group.