G. J. Ramos-Gonzalez1, C. W. Snyder1, P. D. Danielson1, M. Mosha2, N. M. Chandler1 1Johns Hopkins All Children’s Hospital, Surgery, Saint Petersburg, FL, USA 2Johns Hopkins All Children’s Hospital, Health Informatics, Saint Petersburg, FL, USA
Introduction: Optimal management of complicated appendicitis requires adequate source control, and appropriate selection, dosing and timing of antimicrobial therapy. There is often considerable variability in the antibiotic regimen initiated. The aim of this study was to explore the association of post-appendectomy organ space infection (OSI) based on the initial antibiotic received during the management of complicated appendicitis.
Methods: The NSQIP-Pediatric database at a single institution was queried for patients <18 years with complicated appendicitis that underwent laparoscopic appendectomy between January 2017 and December 2021. Supplemental chart review was performed for additional data elements. Time and spectrum of initial antibiotic received was recorded as were times from diagnosis to antibiotic administration and time to appendectomy. Postoperative antibiotic therapy was standardized. The primary outcome was the development of post-appendectomy OSI. Multiple regression analysis was used to control for antibiotic spectrum, antibiotic timing, and time to appendectomy.
Results: The cohort consisted of 197 patients with complicated appendicitis; of which 75.6% (149/197) included complete data and formed the population for analysis. Median age was 11 years (IQR 7.5-14.3) with 59% males. Transfers from outlying facilities accounted for 52% (78/149). Overall, 19% (29/149) of patients developed OSI, with 16% (24/149) requiring percutaneous drainage. There was a significant difference in the development of OSI based on the initial antibiotic therapy: Pip/Tazo 33% (14/42), Ctx/Mtz 11% (5/46), Cefoxitin 15% (8/52) and other regimens 22% (2/9) (p=0.047). In addition, patients who developed OSI had significantly higher median times from initial administration of antibiotic to surgery (322 [IQR 151-518] vs. 177 [IQR 84-389] min; p=0.011) and time from presentation at our institution to surgery (648 [IQR 453-1065] vs. 515 [IQR 286-706] min; p=0.014). Time from diagnosis to initial administration of antibiotics (250 [IQR 88-445] vs. 227 [IQR 90-465] min; p=0.352) was not significant for those with OSI. Multivariable analysis (Table 1) shows that while controlling for time from diagnosis to antibiotics and time from antibiotics to surgery, there is no significant difference between the initial antibiotic therapy given and the post-operative development of OSI.
Conclusion: Initial antibiotic selection in the management of complicated appendicitis was not associated with the development of post-appendectomy organ space infection in children with perforated appendicitis.
