探讨口服抗生素在儿科复杂阑尾炎非手术治疗中的抗生素管理。

Antimicrobial stewardship & healthcare epidemiology : ASHE Pub Date : 2025-04-25 eCollection Date: 2025-01-01 DOI:10.1017/ash.2025.74
Rebecca John, Alvaro E Galvis, Robert F T Bucayu, John Schomberg, Yigit Guner, Antonio Arrieta, Delma Nieves
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引用次数: 0

摘要

培养数据可能有助于确定非手术复杂性阑尾炎的抗生素给药方案。治疗策略存在差异,从单纯使用静脉治疗,包括门诊静脉注射抗生素治疗(OPAT)到过渡到口服抗生素治疗(PO)。我们假设根据培养结果,大多数患者都有口服抗生素的选择,并且由于口服抗生素治疗失败,再入院率没有增加。方法:这是一项单中心回顾性队列研究,回顾了经介入放射(IR)经皮引流的复杂阑尾炎脓肿患儿非手术治疗的抗生素治疗。我们比较了病例混合人口统计学变量、抗生素治疗的选择和途径、培养数据和只接受肠外抗生素治疗(PAT)和转而接受口服治疗(PO)的患者的临床结果。结果:2014 - 2019年,54例非手术性阑尾炎患者行IR脓肿引流术。45例(83%)患者完成了PAT治疗,9例完成了PO治疗;54例患者中有46例(85%)患者根据敏感性选择口服抗生素。再入院和并发症6例(11%)。3例(50%)患者因抗生素治疗失败并脓肿形成恶化而再次入院,2例因PICC(外周插入中心导管)问题,1例因药物反应。结论:大多数非手术性复杂阑尾炎患者可根据培养敏感性过渡到口服抗生素方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exploring oral antibiotics for antibiotic stewardship in nonoperative management of complicated appendicitis in pediatric patients.

Introduction: Culture data may help determine antibiotic administration options for nonoperative complicated appendicitis. Variability exists in treatment strategies, from solely using intravenous therapy, including outpatient parenteral antibiotic treatment (OPAT), to transitioning to oral (PO) antibiotics. We hypothesize that most patients have an oral antibiotic option based on culture results and that there is no increased rate of readmission due to treatment failure with oral antibiotics.

Methods: This was a single-center retrospective cohort study reviewing antibiotic treatment of pediatric patients treated with nonoperative management for complicated appendicitis with abscesses percutaneously drained by Interventional Radiology (IR). We compared case-mix demographic variables, choice and route of antibiotic therapy, culture data, and clinical outcomes between those who exclusively received parenteral antibiotics therapy (PAT) and those who were switched to oral therapy (PO).

Results: We identified 54 cases of nonoperative complicated appendicitis who underwent IR abscess drainage from 2014 to 2019. Forty-five [83%] patients completed therapy with PAT and 9 with PO; forty-six of 54 patients (85%) patients had an oral antibiotic(s) option based on sensitivities. Readmissions and complications included 6 (11%) patients. Three (50%) patients were readmitted due to antibiotic treatment failure with worsening of abscess formation, 2 due to PICC (peripherally inserted central catheters) issues, and 1 due to a drug reaction.

Conclusions: Most patients with nonoperative complicated appendicitis can be transitioned to oral antibiotic options based on the culture susceptibility profiles.

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