Use of Antipseudomonal Antibiotics is not Associated with Lower Rates of Postoperative Drainage Procedures or More Favorable Culture Profiles in Children with Complicated Appendicitis-Reference-Cited by-同舟云学术

Use of Antipseudomonal Antibiotics is not Associated with Lower Rates of Postoperative Drainage Procedures or More Favorable Culture Profiles in Children with Complicated Appendicitis

Published:2023-11-16 Issue: Volume: Page:
ISSN:0003-4932
Container-title:Annals of Surgery
language:en
Short-container-title:

Author:

Cramm Shannon L.¹,Graham Dionne A.²,Feng Christina³,Allukian Myron⁴,Blakely Martin L.⁵,Chandler Nicole M.⁶,Cowles Robert A.⁷,Kunisaki Shaun M.⁸,Lipskar Aaron M.⁹,Russell Robert T.¹⁰,Santore Matthew T.¹¹,Campbell Brendan T.¹²,Commander Sarah J.¹³,DeFazio Jennifer R.¹⁴,Dukleska Katerina¹²,Echols Justice C.¹⁵,Esparaz Joseph R.¹⁰,Gerall Claire¹⁶,Griggs Cornelia L.¹⁷,Hanna David N.⁵,He Katherine¹,Keane Olivia A.¹¹,McLean Sean E.¹⁸,Pace Elizabeth¹⁹,Scholz Stefan¹⁹,Sferra Shelby R.⁸,Tracy Elisabeth T.²⁰,Zhang Lucy⁷,Rangel Shawn J.¹,

Affiliation:

1. Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA

2. Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, MA

3. Department of Surgery, Children’s National Hospital, Washington, D.C

4. Division of Pediatric, General, Thoracic, and Fetal Surgery, Children’s Hospital of Philadelphia, Perelman Medical School at the University of Pennsylvania, Philadelphia, PA

5. Division of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN

6. Division of Pediatric Surgery, Johns Hopkin’s All Children’s Hospital, St. Petersburg, FL

7. Department of Pediatric Surgery, Yale New Haven Children’s Hospital, Yale School of Medicine, New Haven, CT

8. Department of Surgery, Johns Hopkins Children’s Center, Johns Hopkins School of Medicine, Baltimore, MD

9. Division of Pediatric Surgery, Cohen Children’s Medical Center, Zucker School of Medicine at Hoftsra/Northwell, New Hyde Park, NY

10. Division of Pediatric Surgery, Children’s of Alabama; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL

11. Department of Surgery, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA

12. Department of Surgery, Connecticut Children’s Hospital, Hartford, CT

13. Department of Surgery, Duke Children’s Hospital and Health Center, Durham, NC

14. Division of Pediatric Surgery, New York Presbyterian Morgan Stanley Children’s Hospital, Columbia University Vagelos College of Physcians and Surgeons, New York, NY

15. Department of Surgery, University of North Carolina Health System, University of North Carolina School of Medicine, Chapel Hill, NC

16. Department of Surgery, UT Health San Antonio, San Antonio, TX

17. Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA

18. Division of Pediatric Surgery, University of North Carolina Health System, University of North Carolina School of Medicine, Chapel Hill, NC

19. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA

20. Department of Surgery, Duke Children’s Hospital and Health Center, Duke University School of Medicine, Durham, NC

Abstract

Objective: To compare rates of postoperative drainage and culture profiles in children with complicated appendicitis treated with the two most common antibiotic regimens with and without antipseudomonal activity (piperacillin-tazobactam [PT] and ceftriaxone with metronidazole [CM]). Summary of Background Data: Variation in use of antipseudomonal antibiotics has been driven by a paucity of multicenter data reporting clinically relevant, culture-based outcomes. Methods: Retrospective cohort study of patients with complicated appendicitis (7/2015-6/2020) using NSQIP-Pediatric data from 15 hospitals participating in a regional research consortium. Operative report details, antibiotic utilization, and culture data were obtained through supplemental chart review. Rates of 30-day postoperative drainage and organism-specific culture positivity were compared between groups using mixed effects regression to adjust for clustering after propensity matching on measures of disease severity. Results: 1002 children met criteria for matching (58.9% received CM and 41.1% received PT). In the matched sample of 778 patients, children treated with PT had similar rates of drainage overall (PT: 11.8%, CM: 12.1%; OR 1.44 [OR:0.71-2.94]) and higher rates of drainage associated with growth of any organism (PT: 7.7%, CM: 4.6%; OR 2.41 [95%CI:1.08-5.39]) and Escherichia coli (PT: 4.6%, CM: 1.8%; OR 3.42 [95%CI:1.07-10.92]) compared to treatment with CM. Rates were similar between groups for drainage associated with multiple organisms (PT: 2.6%, CM: 1.5%; OR 3.81 [95%CI:0.96-15.08]) and Pseudomonas (PT: 1.0%, CM: 1.3%; OR 3.42 [95%CI:0.55-21.28]). Conclusions and Relevance: Use of antipseudomonal antibiotics is not associated with lower rates of postoperative drainage procedures or more favorable culture profiles in children with complicated appendicitis.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery