Department of Surgery, Boston Children's Hospital - Harvard Medical School, Boston, MA.
Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA.
Ann Surg. 2018 Jul;268(1):186-192. doi: 10.1097/SLA.0000000000002349.
The aim of this study was to compare the effectiveness of extended versus narrow spectrum antibiotics in preventing surgical site infections (SSIs) and hospital revisits in children with uncomplicated appendicitis.
There is a paucity of high-quality evidence in the pediatric literature comparing the effectiveness of extended versus narrow-spectrum antibiotics in the prevention of SSIs associated with uncomplicated appendicitis.
Clinical data from the ACS NSQIP-Pediatric Appendectomy Pilot Project were merged with antibiotic utilization data from the Pediatric Health Information System database for patients undergoing appendectomy for uncomplicated appendicitis at 17 hospitals from January 1, 2013 to June 30, 2015. Patients who received piperacillin/tazobactam (extended spectrum) were compared with those who received either cefoxitin or ceftriaxone with metronidazole (narrow spectrum) after propensity matching on demographic and severity characteristics. Study outcomes were 30-day SSI and hospital revisit rates.
Of the 1389 patients included, 39.1% received piperacillin/tazobactam (range by hospital: 0% to 100%), and the remainder received narrow-spectrum agents. No differences in demographics or severity characteristics were found between groups following matching. In the matched analysis, the rates of SSI were similar between groups [extended spectrum: 2.4% vs narrow spectrum 1.8% (odds ratio, OR: 1.05, 95% confidence interval, 95% CI 0.34-3.26)], as was the rate of revisits [extended spectrum: 7.9% vs narrow spectrum 5.1% (OR: 1.46, 95% CI 0.75-2.87)].
Use of extended-spectrum antibiotics was not associated with lower rates of SSI or hospital revisits when compared with narrow-spectrum antibiotics in children with uncomplicated appendicitis. Our results challenge the routine use of extended-spectrum antibiotics observed at many hospitals, particularly given the increasing incidence of antibiotic-resistant organisms.
本研究旨在比较广谱与窄谱抗生素在预防单纯性阑尾炎患儿手术部位感染（SSI）和医院复诊方面的有效性。
在儿科文献中，比较单纯性阑尾炎相关 SSI 预防中广谱与窄谱抗生素有效性的高质量证据十分匮乏。
将 ACS NSQIP-小儿阑尾切除术试点项目的临床数据与 2013 年 1 月 1 日至 2015 年 6 月 30 日 17 家医院小儿健康信息系统数据库中抗生素使用数据合并，对接受单纯性阑尾炎切除术的患者进行分析。对人口统计学和严重程度特征进行倾向评分匹配后，比较接受哌拉西林/他唑巴坦（广谱）的患者与接受头孢西丁或头孢曲松加甲硝唑（窄谱）的患者。研究结果为 30 天 SSI 和医院复诊率。
在纳入的 1389 例患者中，39.1%接受了哌拉西林/他唑巴坦（各医院范围：0%至 100%），其余患者接受了窄谱抗生素。匹配后两组患者在人口统计学和严重程度特征方面无差异。在匹配分析中，两组 SSI 发生率相似[广谱组：2.4% vs 窄谱组：1.8%（比值比，OR：1.05，95%置信区间，95%CI：0.34-3.26]，复诊率也相似[广谱组：7.9% vs 窄谱组：5.1%（OR：1.46，95%CI：0.75-2.87）]。
与窄谱抗生素相比，在单纯性阑尾炎患儿中使用广谱抗生素并不会降低 SSI 或医院复诊率。我们的结果对许多医院常规使用广谱抗生素提出了挑战，尤其是考虑到抗生素耐药菌的发生率不断增加。
