Children's Hospital of Wisconsin and Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI.
J Pediatr Surg. 2020 Mar;55(3):406-413. doi: 10.1016/j.jpedsurg.2019.07.004. Epub 2019 Jul 19.
Ambiguity regarding timing and duration of perioperative IV antibiotics in AA and CA exists. We wanted to determine if an association existed between surgical site infections (SSI) in children with acute (AA) or complicated appendicitis (CA) and timing and duration of perioperative antibiotics.
We performed a single institution, case control observational study of patients with (n = 988) and CA (n = 561) from 2013 to 2017. The exposure was the timing and/or duration of pre- and postoperative antibiotics. The outcome measure was SSI development within 60 days of surgery.
SSI occurred in 2.5% AA and 19.1% CA patients. We identified 18-70 min before incision (MBI) as the best interval for preoperative antibiotic administration with regards to SSI occurrence with SSI OR = 3.0 (95% CI 1.35, 6.68) p = 0.0356 for antibiotics given 0-17 MBI and OR = 3.21 (95% CI 1.45, 7.09) p = 0.0108) for antibiotics given >70 MBI. Postoperative antibiotics did not confer protection from SSI in AA patients (p = 0.718). CA patients who achieved normal physiologic indices within ≤6 days (Early Responders, ER) had 8.8% SSI while the Late Responders (LR, normal by >6 days) had 49.3% SSI rate (p < 0.001). ER patients who received IV antibiotics for 1-2 postoperative days had higher SSI rates compared to 3, 4, 5, or 6 days, but higher odds of SSI were found only with 1 day. Additional oral antibiotics decreased SSI for ER (OR 0.36, 95% CI 0.159, 0.87; p = 0.0145), but not LR patients (OR 1.25, 95% CI 0.55, 2.85, p = 0.5951).
Antibiotics given within 18-70 MBI for appendectomy may be associated with decreased SSI. Postoperative antibiotics should not be given for AA. In ER CA patients, additional oral antibiotics may decrease SSI.
Level III.
Retrospective comparative study.
在急性阑尾炎（AA）和复杂性阑尾炎（CA）中，围手术期 IV 抗生素的时间和持续时间存在模糊性。我们想确定儿童急性（AA）或复杂性阑尾炎（CA）的手术部位感染（SSI）与围手术期抗生素的时间和持续时间是否存在关联。
我们对 2013 年至 2017 年期间的 988 例 AA 和 561 例 CA 患者进行了单机构病例对照观察性研究。暴露因素是术前和术后抗生素的时间和/或持续时间。结局指标为术后 60 天内发生 SSI。
AA 组和 CA 组 SSI 发生率分别为 2.5%和 19.1%。我们发现，在切开前 18-70 分钟（MBI）给予抗生素是预防 SSI 发生的最佳时间间隔，与 0-17 MBI 之间给予抗生素相比，SSI 发生率 OR=3.0（95%CI 1.35，6.68），p=0.0356；与 70 MBI 以上给予抗生素相比，OR=3.21（95%CI 1.45，7.09），p=0.0108。AA 患者术后使用抗生素并不能预防 SSI（p=0.718）。在 CA 患者中，在≤6 天内恢复正常生理指标的患者（早期应答者，ER）的 SSI 发生率为 8.8%，而恢复时间超过 6 天的患者（迟发应答者，LR）的 SSI 发生率为 49.3%（p<0.001）。ER 患者术后接受 1-2 天静脉抗生素治疗的 SSI 发生率高于 3、4、5 或 6 天，但仅 1 天的 SSI 发生率更高。额外的口服抗生素可降低 ER 患者的 SSI（OR 0.36，95%CI 0.159，0.87；p=0.0145），但对 LR 患者无影响（OR 1.25，95%CI 0.55，2.85，p=0.5951）。
阑尾切除术前 18-70MBI 给予抗生素可能与 SSI 发生率降低有关。AA 患者不应给予术后抗生素。在 ER CA 患者中，额外的口服抗生素可能会降低 SSI 的发生率。
III 级。
回顾性比较研究。
