Appendicitis in childhood: reduction in wound infection with preoperative antibiotics

Area of Science:

• Pediatric surgery
• Infectious disease prevention
• Clinical microbiology

Background:

• Appendicectomy for acute appendicitis in children historically has a notable rate of surgical site infections.
• Implementing effective prophylactic antibiotic strategies is crucial for improving patient outcomes and reducing healthcare burdens.

Purpose of the Study:

• To evaluate the impact of preoperative prophylactic antibiotics on reducing wound infection rates following appendicectomy in children.
• To compare current infection rates with historical data and assess the efficacy of specific antibiotic regimens.

Main Methods:

• A consecutive series of 118 children undergoing appendicectomy for histologically confirmed acute appendicitis were treated with preoperative prophylactic antibiotics.
• Wound infection rates, including serious wound abscesses and postoperative abdominal abscesses, were meticulously recorded.
• Infection rates were compared to the author's previous unpublished data (8%) and a published series (37%).

Main Results:

• A significant reduction in wound infection was observed, with an overall rate of 2.5% (3 out of 118 children).
• Only one serious wound abscess (0.8%) occurred, and no postoperative abdominal abscesses were reported.
• The infection rate in this series is comparable to that of clean surgical procedures like herniorrhaphy.

Conclusions:

• Preoperative prophylactic antibiotics are highly effective in reducing wound infections after pediatric appendicectomy.
• For uncomplicated appendicitis, cefoxitin may be sufficient, while complicated cases benefit from combination therapy (e.g., cefoxitin with metronidazole or lincomycin with an aminoglycoside).
• The findings support the routine use of appropriate prophylactic antibiotics to minimize surgical site infections in this patient population.