Department of Surgery, Tergooi Hospital, PO Box 10016, 1201 DA Hilversum, The Netherlands.
Br J Surg. 2014 May;101(6):715-9. doi: 10.1002/bjs.9481. Epub 2014 Mar 26.
Antibiotic treatment after appendicectomy for complicated appendicitis aims to reduce postoperative infections. However, available data on the duration of treatment are limited. This study compared the difference in infectious complications between two protocols, involving either 3 or 5 days of postoperative antibiotic treatment.
This was an observational cohort study of all adult patients who had an appendicectomy between January 2004 and December 2010 at either one of two hospitals in the same region. At location A, the protocol included 3 days of postoperative antibiotic treatment, whereas at location B it specified 5 days. The primary outcome was the development of postoperative infections as either superficial wound infection or deep intra-abdominal infections.
A total of 1143 patients with acute appendicitis underwent appendicectomy, of whom 267 (23.4 per cent) had complicated appendicitis. The duration of postoperative antibiotic treatment was 3 days in 135 patients (50.6 per cent) and at least 5 days in 123 (46.1 per cent). No difference was found between antibiotic treatment for 3 or 5 days in terms of developing an intra-abdominal abscess (odds ratio (OR) 1.77, 95 per cent confidence interval 0.68 to 4.58; P = 0.242) or a wound infection (OR 2.74, 0.54 to 13.80; P = 0.223). In patients with complicated appendicitis, the laparoscopic approach was identified as a risk factor for developing an intra-abdominal abscess in univariable analysis (OR 2.46, 1.00 to 6.04; P = 0.049), but was not confirmed as an independent risk factor for this complication in multivariable analysis (OR 2.32, 0.75 to 7.14; P = 0.144).
After appendicectomy for complicated appendicitis, 3 days of antibiotic treatment is equally effective as 5 days in reducing postoperative infections.
阑尾切除术后使用抗生素治疗复杂性阑尾炎旨在减少术后感染。然而，关于治疗持续时间的现有数据有限。本研究比较了两种方案（术后使用抗生素 3 天或 5 天）在感染性并发症方面的差异。
这是一项观察性队列研究，纳入了 2004 年 1 月至 2010 年 12 月期间在同一地区的两家医院接受阑尾切除术的所有成年患者。在地点 A，方案包括术后抗生素治疗 3 天，而在地点 B，方案规定为 5 天。主要结局是发生术后感染，包括浅表伤口感染或深部腹腔内感染。
共有 1143 例急性阑尾炎患者接受阑尾切除术，其中 267 例（23.4%）为复杂性阑尾炎。135 例（50.6%）患者的术后抗生素治疗持续 3 天，123 例（46.1%）患者至少治疗 5 天。在发生腹腔脓肿（比值比（OR）1.77，95%置信区间 0.68 至 4.58；P=0.242）或伤口感染（OR 2.74，0.54 至 13.80；P=0.223）方面，3 天与 5 天抗生素治疗无差异。在复杂性阑尾炎患者中，腹腔镜方法在单变量分析中被确定为发生腹腔脓肿的危险因素（OR 2.46，1.00 至 6.04；P=0.049），但在多变量分析中未被确认为该并发症的独立危险因素（OR 2.32，0.75 至 7.14；P=0.144）。
阑尾切除术后治疗复杂性阑尾炎，3 天的抗生素治疗与 5 天治疗在减少术后感染方面同样有效。
