Shai Stewart, Cory Nonnemacher, Seth Saylors, Nelimar Cruz-Centeno, Derek Marlor, Dae H Kim, Shawn St Peter, Tolulope A Oyetunji
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引用次数: 0
Abstract
Background: 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.
Methods: 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.
Results: 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].
Conclusions: 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.
背景:对于穿孔性阑尾炎的最佳抗生素治疗方案尚无共识。我们的目的是评估穿孔阑尾炎患者接受哌拉西林-他唑巴坦(PT)单药治疗与头孢曲松和甲硝唑(CM)双药治疗的结果。我们假设,与我们的机构标准双药治疗相比,抗生素单药治疗在腹内脓肿(IAA)形成率方面没有差异。方法:对儿童进行单机构回顾性分析。结果:在研究期间共发现117例患者;CM组N = 77, PT组N = 40。在症状持续时间、术后住院时间(LOS)、静脉抗生素治疗时间或出院时口服抗生素治疗方面没有发现差异。与PT组相比,CM组IAA较少(13% vs 20%, P = 0.32),急诊次数较少(14.3% vs 27.5%, P = 0.08),但差异无统计学意义。多因素logistic回归分析未发现抗生素选择是发生IAA的显著预测因子[OR 1.78, P = 0.21]。结论:对于穿孔性阑尾炎患儿,术后单药PT治疗与标准双药CM治疗在IAA形成方面是相同的。
期刊介绍:
Pediatric Surgery International is a journal devoted to the publication of new and important information from the entire spectrum of pediatric surgery. The major purpose of the journal is to promote postgraduate training and further education in the surgery of infants and children.
The contents will include articles in clinical and experimental surgery, as well as related fields. One section of each issue is devoted to a special topic, with invited contributions from recognized authorities. Other sections will include:
-Review articles-
Original articles-
Technical innovations-
Letters to the editor