Stewart Shai, Nonnemacher Cory, Saylors Seth, Cruz-Centeno Nelimar, Marlor Derek, Kim Dae H, Peter Shawn St, Oyetunji Tolulope A
Department of Pediatric Surgery, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA.
Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA.
Pediatr Surg Int. 2025 Jul 22;41(1):225. doi: 10.1007/s00383-025-06129-0.
There is no consensus on the optimal antibiotic regimen in perforated appendicitis. We aimed to evaluate the outcomes of patients with perforated appendicitis when treated with Piperacillin-Tazobactam (PT) monotherapy versus Ceftriaxone and Metronidazole (CM) dual-drug therapy. We hypothesized that there is no difference in the rate of intraabdominal abscess (IAA) formation with antibiotic monotherapy, as opposed to our institutional standard dual-drug therapy.
Single institution retrospective review of children < 18 years old with perforated appendicitis from October 2019 to March 2020 and October 2021 to May 2022 at a free-standing pediatric hospital. The primary outcome was 30-day postoperative IAA formation.
One hundred and seventeen patients were identified during the study periods; N = 77 in the CM group and N = 40 in the PT group. No differences in symptom duration, postoperative length of stay (LOS), duration of intravenous antibiotic treatment, or discharge oral antibiotic treatment were identified. Compared to the PT group, those treated with CM had fewer IAA (13% vs 20%, P = 0.32) and fewer emergency room visits (14.3% vs 27.5%, P = 0.08) but did not have statistically significant differences. Multivariate logistic regression analysis did not find antibiotic choice to be a significant predictor for developing IAA [OR 1.78, P = 0.21].
In children with perforated appendicitis, postoperative monotherapy with PT and standard dual-drug therapy with CM are equivalent with respect to IAA formation at our institution.
对于穿孔性阑尾炎的最佳抗生素治疗方案尚无共识。我们旨在评估哌拉西林-他唑巴坦（PT）单药治疗与头孢曲松和甲硝唑（CM）联合治疗穿孔性阑尾炎患者的疗效。我们假设与我们机构的标准联合用药治疗相比，抗生素单药治疗在腹腔内脓肿（IAA）形成率上没有差异。
对一家独立儿科医院2019年10月至2020年3月以及2021年10月至2022年5月期间18岁以下的穿孔性阑尾炎患儿进行单机构回顾性研究。主要结局是术后30天IAA的形成。
在研究期间共确定了117例患者；CM组77例，PT组40例。在症状持续时间、术后住院时间（LOS）、静脉抗生素治疗持续时间或出院口服抗生素治疗方面未发现差异。与PT组相比，接受CM治疗的患者IAA较少（13%对20%，P = 0.32），急诊就诊次数较少（14.3%对27.5%，P = 0.08），但差异无统计学意义。多因素逻辑回归分析未发现抗生素选择是发生IAA的显著预测因素[比值比1.78，P = 0.21]。
在穿孔性阑尾炎患儿中，在我们机构，PT术后单药治疗和CM标准联合用药治疗在IAA形成方面效果相当。
