头孢曲松联合甲硝唑与哌拉西林/他唑巴坦治疗儿童复杂性阑尾炎的多中心儿科 NSQIP 分析结果。
Ceftriaxone with Metronidazole versus Piperacillin/Tazobactam in the management of complicated appendicitis in children: Results from a multicenter pediatric NSQIP analysis.
机构信息
Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA, United States.
出版信息
J Pediatr Surg. 2022 Oct;57(10):365-372. doi: 10.1016/j.jpedsurg.2021.11.009. Epub 2021 Nov 20.
BACKGROUND
Narrow-spectrum antibiotics have been found to be equivalent to anti-Pseudomonal agents in preventing organ space infections (OSI) in children with uncomplicated appendicitis. Comparative effectiveness data for children with complicated appendicitis remains limited. This investigation aimed to compare outcomes between the most common narrow-spectrum regimen (ceftriaxone with metronidazole: CM) and anti-Pseudomonal regimen (piperacillin/tazobactam: PT) used perioperatively in children with complicated appendicitis.
METHODS
Multicenter retrospective cohort study using clinical data from the NSQIP-Pediatric Appendectomy Collaborative database merged with antibiotic utilization data from the Pediatric Health Information System database. Mixed-effects multivariate regression was used to compare NSQIP-defined outcomes and resource utilization between treatment groups after adjusting for patient characteristics, disease severity, and clustering of outcomes within hospitals.
RESULTS
654 patients from 14 hospitals were included, of which 37.9% received CM and 62.1% received PT. Following adjustment, patients in both groups had similar rates of OSI (CM: 13.3% vs. PT: 18.0%, OR 0.88 [95%CI 0.38, 2.03]), drainage procedures (CM: 8.9% vs. PT: 14.9%, OR 0.76 [95%CI 0.30, 1.92]), and postoperative imaging (CM: 19.8% vs. PT: 22.5%, OR 1.17 [95%CI 0.65, 2.12]). Treatment groups also had similar rates of 30-day cumulative post-operative length of stay (CM: 6.1 vs. PT: 6.0 days, RR 1.01 [95%CI 0.81, 1.25]) and hospital cost (CM: $19,235 vs. PT: $20,552, RR 0.92 [95%CI 0.69, 1.23]).
CONCLUSIONS
Rates of organ space infection and resource utilization were similar in children with complicated appendicitis treated with ceftriaxone plus metronidazole and piperacillin/tazobactam.
LEVEL OF EVIDENCE
Level III: Treatment study - Retrospective comparative study.
背景
窄谱抗生素已被发现与抗假单胞菌药物在预防儿童单纯性阑尾炎的器官间隙感染（OSI）方面等效。对于复杂性阑尾炎患儿，比较有效性数据仍然有限。本研究旨在比较围手术期最常用的窄谱方案（头孢曲松加甲硝唑：CM）和抗假单胞菌方案（哌拉西林/他唑巴坦：PT）在复杂性阑尾炎患儿中的疗效。
方法
利用 NSQIP-小儿阑尾切除术协作数据库的临床数据和小儿健康信息系统数据库的抗生素使用数据，进行多中心回顾性队列研究。采用混合效应多元回归比较治疗组之间 NSQIP 定义的结局和资源利用情况，调整患者特征、疾病严重程度和医院内结局聚类。
结果
纳入来自 14 家医院的 654 名患者，其中 37.9%接受 CM 治疗，62.1%接受 PT 治疗。调整后，两组患者的 OSI 发生率（CM：13.3% vs. PT：18.0%，OR 0.88 [95%CI 0.38, 2.03]）、引流术（CM：8.9% vs. PT：14.9%，OR 0.76 [95%CI 0.30, 1.92]）和术后影像学检查（CM：19.8% vs. PT：22.5%，OR 1.17 [95%CI 0.65, 2.12]）均相似。两组 30 天累计术后住院时间（CM：6.1 天 vs. PT：6.0 天，RR 1.01 [95%CI 0.81, 1.25]）和住院费用（CM：$19235 美元 vs. PT：$20552 美元，RR 0.92 [95%CI 0.69, 1.23]）也相似。
结论
在接受头孢曲松加甲硝唑和哌拉西林/他唑巴坦治疗的复杂性阑尾炎患儿中，器官间隙感染发生率和资源利用情况相似。
证据水平
III 级：治疗研究-回顾性比较研究。
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