1442. Simplified Approach to the Treatment of Ruptured Appendicitis in a Pediatric Population
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
  • Rup. Appy IDWeek Poster .pdf (547.5 kB)
  • Background: A combination of antibiotics offering broad coverage of enteric bacteria is usually required to reduce the risk of infection after ruptured appendicitis surgery. In 2006, St. Peter, et al. published a simplified regimen of once daily ceftriaxone and metronidazole which was shown to be more cost effective without demonstrating any negative impact in terms of complications.

    Methods: The Antibiotic Stewardship Committee at Phoenix Children’s Hospital undertook this quality improvement project to apply the simplified regimen described by St. Peter et al. at our institution.  Cost and rate of complications were analyzed after the implementation of a standard order set protocol for post-surgical treatment with the simplified combination of once daily ceftriaxone and metronidazole.   The target population was children with ruptured appendicitis without an abscess at the time of presentation.   ICD-9 codes were used to identify patients in a retrospective fashion using the following criteria:  Age between 2-18 years, minimum of a 5-day hospitalization, and lack of evidence of abscess at presentation.  A 6 month period after implementation of the new protocol (post-group) was compared to a 6 month period before it was implemented (pre-group).  Antibiotic costs and rates of complications were compared using a student’s T-test to calculate p-value.

    Results: A total of 150 potential patients were identified using ICD-9 codes.  31 patients met the criteria for the pre-intervention period and 32 patients met the criteria for the post-intervention period. A total of 1070 doses of antibiotics were administered to the pre-group as compared to 373 doses in the post-group.  The cost of antibiotic therapy in the pre-group was estimated to be $34,152.66 as compared to $11,988.47 in the post-group.  Per patient antibiotic costs declined from an average of $2,053 per patient to $798.47 (p = 0.0001). Review of incident reports and readmission rates showed no increases from pre-group patients to post-group.  

    Conclusion: Implementation of an order set encouraging the use of a simplified antibiotic regimen for ruptured appendicitis results in significant cost savings without any increased risk of post-surgical complications.

    Wassim Ballan, MD1, Richard Engel, MD1, Millie Wisdom, PharmD1, Daniel Malone, PhD2, Yanina Ortega, Pharmacy Intern1, Reilly Darling, Quality Assurance Analyst1 and Robin Wasko, M(ASCP)1, (1)Phoenix Children's Hospital, Phoenix, AZ, (2)University of Arizona, Phoenix, AZ


    W. Ballan, None

    R. Engel, None

    M. Wisdom, None

    D. Malone, None

    Y. Ortega, None

    R. Darling, None

    R. Wasko, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.