Splitting hairs and challenging guidelines: Defining the role of perioperative antibiotics in pediatric appendicitis patients. J Pediatr Surg 2020 Mar;55(3):406-413
Date
08/01/2019Pubmed ID
31362826DOI
10.1016/j.jpedsurg.2019.07.004Scopus ID
2-s2.0-85069635286 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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 OF EVIDENCE: Level III.
TYPE OF STUDY: Retrospective comparative study.
Author List
Somers KK, Eastwood D, Liu Y, Arca MJMESH terms used to index this publication - Major topics in bold
Anti-Bacterial AgentsAntibiotic Prophylaxis
Appendectomy
Appendicitis
Child
Humans
Retrospective Studies
Surgical Wound Infection
Time-to-Treatment