Methods: A comprehensive CPG for all children with complicated appendicitis was implemented in July 2013. The CPG calls for peri- and postoperative piperacillin-tazobactam until the patient tolerates oral medications, followed by oral ciprofloxacin and metronidazole for 7 additional days. We compared inpatient and outpatient antibiotic utilization for all children treated for perforated appendicitis in the 30 months prior to and 16 months after CPG implementation. In addition, we compared the frequency of peripherally-inserted central catheter (PICC) placement and the frequency of relevant adverse events (AE) between the two groups.
Results: Compared to pre-CPG patients (n=191), post-CPG patients (n=122) received fewer days of IV antibiotics (5.8 vs. 9.8, p<0.001) and were less likely to receive aminoglycosides (0.8% vs. 17.8%, p<0.001) or overlapping antibiotics, such as piperacillin-tazobactam plus metronidazole (0% vs. 15.2%, p<0.001). Post-CPG patients were less likely to receive a PICC (2.5% vs. 30.4%, p<0.001) or to receive home IV antibiotic therapy (0% vs. 13.1%, p<0.001). Compliance was high: 96.7% of post-CPG patients received recommended IV antibiotics and 95.9% received recommended oral antibiotics. The frequency of surgical site infections (SSI) was 26.1% in the pre-CPG group and 11.5% in the post-CPG group (p<0.05). 3 of 191 patients (1.6%) in the pre-CPG group had an AE related to PICC or antibiotics, compared to 6 of 122 patients (4.9%) in the post-CPG group (p=0.16).
Conclusion: A CPG for complicated appendicitis reduced exposure to overlapping, excessively broad, and nephrotoxic antibiotic regimens. Total days of IV antibiotic therapy were reduced. The frequency of PICC placement fell dramatically. SSI were significantly less frequent in the post-CPG group. Antibiotic-related adverse events were rare and not severe in both groups. CPG development for this population is a key opportunity for antimicrobial stewardship.
J. Gillon, None
M. Blakely, None
M. C. Di Pentima, None