Beltz Sebastian, Fischer Stephanie, Huenger Frank, Vahdad Reza, Kalhoff Hermann, Leutner Andreas
Department of Pediatric Surgery and Pediatric Urology, Children's Hospital, Klinikum Dortmund, Germany.
University Witten/Herdecke, Witten, Germany.
GMS Hyg Infect Control. 2025 Mar 5;20:Doc06. doi: 10.3205/dgkh000535. eCollection 2025.
Appendectomy is the most frequent emergency abdominal operation in children, who regularly present with complicated acute appendicitis and thus need targeted antibiotic therapy. While in other fields antibiotic stewardship (ABS) is becoming increasingly well established, these principles are not consistently followed in pediatric surgery. With this study, we aimed to analyze the effects of the implementation of an ABS-compliant SOP on the postoperative care of patients.
We compared the quality of antibiotic therapy before and after the implementation of standard operating procedure (SOP) for the peri-/postoperative antibiotic treatment of appendicitis in 2020. Pediatric patients who had undergone appendectomy were evaluated based on an algorithm presenting recommended antibiotic therapy of appendicitis, according to the current literature and good clinical practice. 165 patients were evaluated before and 209 patients after the implementation of SOP.
The mean number of cases in which antibiotic therapy was given postoperatively was 10.5% lower (p-value 0.036) and the median quality-of-treatment score increased by 31.2% (p<0.0001) after the implementation of the SOP. The median length of antibiotic treatment in cases of advanced-stage appendicitis was 2.0 days shorter (p=0.062). The rate of oral antibiotic treatment after discharge decreased by 25.6% (p<0.0001). We observed no significant effects on the median length of hospital stay or the complication rate.
The implementation of SOP based on the principles of ABS positively influenced the quality of treatment after pediatric appendectomy. The algorithm developed in this study may help pediatric surgeons to improve their antimicrobial assessment.
阑尾切除术是儿童最常见的急诊腹部手术，儿童经常出现复杂的急性阑尾炎，因此需要针对性的抗生素治疗。虽然抗生素管理（ABS）在其他领域越来越完善，但这些原则在小儿外科手术中并未得到始终如一的遵循。通过本研究，我们旨在分析实施符合ABS的标准操作程序（SOP）对患者术后护理的影响。
我们比较了2020年实施阑尾炎围手术期/术后抗生素治疗标准操作程序（SOP）前后抗生素治疗的质量。根据当前文献和良好临床实践，对接受阑尾切除术的儿科患者按照推荐的阑尾炎抗生素治疗算法进行评估。实施SOP前评估了165例患者，实施后评估了209例患者。
实施SOP后，术后给予抗生素治疗的平均病例数降低了10.5%（p值0.036），治疗质量中位数评分提高了31.2%（p<0.0001）。晚期阑尾炎病例的抗生素治疗中位时长缩短了2.0天（p=0.062）。出院后口服抗生素治疗率下降了25.6%（p<0.0001）。我们未观察到对中位住院时长或并发症发生率有显著影响。
基于ABS原则实施SOP对小儿阑尾切除术后的治疗质量产生了积极影响。本研究制定的算法可能有助于小儿外科医生改善其抗菌评估。
