Comparison of the efficacy of carbapenems and cephalosporins for postoperative treatment of perforated appendicitis in children.

Background: Pediatric perforated appendicitis (PPA) is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy. Antibiotic selection differs significantly among pediatric centers, and an ideal postoperative anti-infective approach for PPA management has yet to be established.

Aim: To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem (CBP) and cephalosporin (CPS) antibiotics.

Methods: We retrospectively analyzed medical records of 65 children (43 boys, 22 girls; mean age 6.92 ± 3.41 years) with PPA who underwent surgery at our hospital between December 2019 and August 2022. Data were collected in September 2023. Based on postoperative antibiotic selection, patients were divided into CBP (32 cases) and CPS (33 cases) groups. Chi-square and T-tests compared recovery outcomes, while univariate and multivariate regression models identified independent factors affecting postoperative recovery.

Results: There were no significant differences between the two groups in gender, age, weight, height, body mass index, baseline ear temperature, or heart rate (P > 0.05). Escherichia coli (40.00%) and Pseudomonas aeruginosa (24.62%) were the most common pathogens in PPA. Postoperative analysis showed significantly shorter C-reactive protein (CRP) recovery times in the CPS group than in the CBP group [(6.18 ± 1.84) vs (8.12 ± 3.48) days, P = 0.009]. Univariate logistic regression indicated CPS selection (OR = 0.32, 95%CI: 0.10-0.97, P = 0.044) was significantly associated with a higher CRP recovery rate within 7 days. Multivariate analysis confirmed CPS selection (OR = 3.49, 95%CI: 1.19-10.24, P = 0.023) as an independent factor affecting CRP recovery within 7 days postoperatively.

Conclusion: The choice of CBP or CPS independently affects CRP recovery within 7 days. CBP offers no advantage over CPS in treating PPA, with CPS also demonstrating favorable clinical outcomes.