Optimizing Antibiotic Management for Adult Patients Presenting with Acute Perforated Appendicitis: A Quality...

Area of Science:

• Surgical Infectious Diseases
• Antibiotic Stewardship
• Quality Improvement in Healthcare

Background:

• Acute appendicitis (AA) is a common surgical emergency, with perforation increasing patient morbidity and mortality.
• Broad-spectrum antibiotic use for AA is prevalent, necessitating strategies for optimization.
• Perforated appendicitis requires careful antibiotic management to prevent complications.

Purpose of the Study:

• To evaluate the impact of a quality improvement initiative on broad-spectrum antibiotic utilization in perforated appendicitis.
• To assess changes in antibiotic prescribing patterns, specifically reducing piperacillin/tazobactam use.
• To determine if reduced broad-spectrum antibiotic use affects surgical site infections (SSIs) and readmission rates.

Main Methods:

• A multisite quality improvement project focused on educating providers and optimizing electronic medical record (EMR) antibiotic order sets.
• Intervention involved encouraging ceftriaxone plus metronidazole and discouraging piperacillin/tazobactam for perforated appendicitis.
• A subset analysis compared 116 patients with perforated appendicitis pre- and post-intervention.

Main Results:

• Piperacillin/tazobactam use decreased from 62.2% to 25.4% (p < 0.0001), while ceftriaxone plus metronidazole use increased from 8.9% to 53.5%.
• Thirty-day readmission rates were similar (15.6% vs. 5.6%, p = 0.104).
• Surgical site infection rates (superficial, deep, organ space) and Clostridium difficile infections remained comparable between groups.

Conclusions:

• Provider education and EMR order optimization can effectively reduce broad-spectrum antibiotic use in perforated appendicitis.
• This approach can be implemented without adversely affecting patient outcomes, such as SSIs or readmissions.
• The findings support antimicrobial stewardship efforts in managing acute perforated appendicitis.