S. Qian1, G. Vasileiou1, G. D. Pust1, A. I. Eid4, C. Dodgion2, T. Zakrison1, M. D. Ray-Zack3, R. Rattan1, N. Namias1, D. D. Yeh1 1University Of Miami,Division Of Trauma And Surgical Critical Care,Miami, FL, USA 2Medical College Of Wisconsin,Division Of Trauma And Critical Care,Milwaukee, WI, USA 3Mayo Clinic,Department Of Surgery,Rochester, MN, USA 4Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA
Introduction: We sought to compare the effectiveness of narrow- vs broad-spectrum antibiotics for adults with simple acute appendicitis.
Methods: In this post hoc analysis of a prospective multicenter observational study of appendicitis in adults (≥18 yrs) conducted from 01/17-05/18, we included patients with simple appendicitis (non-perforated) as diagnosed intra-operatively. Subjects were grouped based on receipt of broad-spectrum antibiotics (3rd or 4th generation cephalosporin, carbapenem, fluoroquinolone, vancomycin, piperacillin/tazobactam, or ampicillin/sulbactam) or narrow-spectrum antibiotics (penicillin, 1st or 2nd generation cephalosporin, beta-lactam, clindamycin, macrolide, aminoglycoside, tetracycline, sulfonamide, amoxicillin/clavulanate, metronidazole, or aztreonam) before and/or after appendectomy. Outcomes compared were surgical site infection (SSI), intra-abdominal abscess (IAI), secondary interventions (percutaneous drainage or operation), Emergency Department (ED) visits, and 30-day readmission.
Results: A total of 1,796 subjects were included for analysis. In comparing Narrow (n=665) vs. Broad (n=1,131) groups, there was no difference in age (39±16 vs. 40 ±16 yrs, p=.266), male sex (49% vs. 52%, p=.186), weight (82.6±21.5 vs. 83.6 ±21.2 kg, p=.352), current tobacco use (18% vs. 17%, p=.125), immunosuppression (4% vs. 4%, p=.763), WBC count (13.2±4.0 vs. 13.6±4.6, p=.053), Alvarado score (6±1 vs. 6±2, p=.636), or Charlson Comorbidity Index (0[0-1] vs. 0[0-1], p=.478). A total of 636 (35%) received post-operative antibiotics, (219 (33%) in the Narrow and 417 (37%) in the Broad group, p=0.092). Of those receiving post-operative antibiotics, 349 (55%) received post-operative antibiotics for ≥ 24 h for a median duration of 4 [2,8] days (88 (40%) in the Narrow and 261(63%) in the Broad group, p<0.001). Cumulative incidence of SSI, IAI, secondary interventions, ED visit, and hospital readmissions are displayed in the Table. Only secondary interventions were significantly more common in the Broad group.
Conclusion: Significant practice variation in duration and spectrum of antibiotic adjunct for surgical treatment of simple acute appendicitis treatment is evident and broad-spectrum antibiotics did not offer clinical advantages over narrow-spectrum antibiotics. Restriction of antibiotic spectrum should be considered, though randomized trials are required to overcome selection bias.
