Splitting hairs and challenging guidelines: Defining the role of perioperative antibiotics in pediatric appendicitis patients

Journal of Pediatric Surgery
Kimberly K SomersMarjorie J Arca

Abstract

Ambiguity regarding timing and duration of perioperative IV antibiotics in AA and CA exists. We wanted to determine if an association existed between surgical site infections (SSI) in children with acute (AA) or complicated appendicitis (CA) and timing and duration of perioperative antibiotics. We performed a single institution, case control observational study of patients with (n = 988) and CA (n = 561) from 2013 to 2017. The exposure was the timing and/or duration of pre- and postoperative antibiotics. The outcome measure was SSI development within 60 days of surgery. SSI occurred in 2.5% AA and 19.1% CA patients. We identified 18-70 min before incision (MBI) as the best interval for preoperative antibiotic administration with regards to SSI occurrence with SSI OR = 3.0 (95% CI 1.35, 6.68) p = 0.0356 for antibiotics given 0-17 MBI and OR = 3.21 (95% CI 1.45, 7.09) p = 0.0108) for antibiotics given >70 MBI. Postoperative antibiotics did not confer protection from SSI in AA patients (p = 0.718). CA patients who achieved normal physiologic indices within ≤6 days (Early Responders, ER) had 8.8% SSI while the Late Responders (LR, normal by >6 days) had 49.3% SSI rate (p < 0.001). ER patients who received IV antibiotics for 1-2 pos...Continue Reading

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