Adams Ursula, Kane Nicholas, Wilson William, Willis Zachary, Eakes Ali M, Dillon Marcia, Akinkuotu Adesola C, McLean Sean E, Charles Anthony G, Phillips Michael R
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Surg Infect (Larchmt). 2025 Feb;26(1):17-23. doi: 10.1089/sur.2024.138. Epub 2024 Nov 4.
There is a lack of consensus on the optimal antibiotic regimen for pediatric appendicitis, and conflicting data exist regarding the need for extended-spectrum use in this population. We implemented an antibiotic stewardship program with a standard, preferred antibiotic regimen for both uncomplicated and complicated appendicitis and hypothesized that clinical outcomes would be equivalent. This is a single-institution, retrospective study of pediatric patients (≤18 y) who underwent appendectomy for acute appendicitis between October 2015 and May 2022. We used institutional data from our stewardship program supplemented by manual chart review. Patients were assigned to pre- and post-pathway cohorts on the basis of appendectomy date. Patients were further stratified on the basis of whether they met criteria for complicated appendicitis on the basis of intra-operative findings. There were 752 patients that were included: 346 (46.0%) in the pre-pathway cohort and 406 (54.0%) in the post-pathway cohort. The pre-pathway cohort had a higher rate of complicated appendicitis (40.2 vs. 25.6%). However, pre- and post-pathway cohorts had similar rates of post-operative infections, readmissions, and reoperations. When separated by complicated operative findings, patients with uncomplicated appendicitis had a shorter length of stay post-pathway implementation (p < 0.001). After controlling for complicated operative findings and pertinent covariates, the preferred antibiotic regimen was independently associated with decreased odds of post-operative organ space surgical site infections (SSI) (adjusted odds ratio 0.22, 95% CI: 0.05-0.99). Antibiotic stewardship to increase the use of a standardized, preferred antibiotic regimen did not result in worse clinical outcomes. The preferred regimen was significantly associated with a decreased rate of organ space SSI, even when controlling for complicated operative findings. The mechanism of this finding requires additional study.
对于小儿阑尾炎的最佳抗生素治疗方案，目前尚无共识，而且关于该人群是否需要使用广谱抗生素的数据也相互矛盾。我们实施了一项抗生素管理计划，针对单纯性和复杂性阑尾炎采用标准的首选抗生素治疗方案，并假设临床结果将是等效的。这是一项单机构的回顾性研究，研究对象为2015年10月至2022年5月期间因急性阑尾炎接受阑尾切除术的儿科患者（≤18岁）。我们使用了来自管理计划的机构数据，并辅以人工病历审查。根据阑尾切除术日期，将患者分为术前和术后队列。根据术中发现，进一步将患者分为是否符合复杂性阑尾炎标准。共纳入752例患者：术前队列346例（46.0%）；术后队列406例（54.0%）。术前队列中复杂性阑尾炎的发生率较高（40.2%对25.6%）。然而，术前和术后队列的术后感染、再入院和再次手术发生率相似。按复杂性手术结果分开后，单纯性阑尾炎患者在实施治疗方案后的住院时间较短（p<0.001）。在控制了复杂性手术结果和相关协变量后，首选抗生素治疗方案与术后器官间隙手术部位感染（SSI）几率降低独立相关（调整后的优势比为0.22，95%置信区间：0.05-0.99）。采用抗生素管理以增加标准化首选抗生素治疗方案的使用，并未导致更差的临床结果。即使在控制了复杂性手术结果后，首选治疗方案仍与器官间隙SSI发生率降低显著相关。这一发现的机制需要进一步研究。
