학술논문
Use of Antipseudomonal Antibiotics is not Associated with Lower Rates of Postoperative Drainage Procedures or More Favorable Culture Profiles in Children with Complicated Appendicitis: Results from a Multicenter Regional Research Consortium
Document Type
Academic Journal
Author
Cramm, Shannon L.; Graham, Dionne A.; Feng, Christina; Allukian, Myron; Blakely, Martin L.; Chandler, Nicole M.; Cowles, Robert A.; Kunisaki, Shaun M.; Lipskar, Aaron M.; Russell, Robert T.; Santore, Matthew T.; Campbell, Brendan T.; Commander, Sarah J.; DeFazio, Jennifer R.; Dukleska, Katerina; Echols, Justice C.; Esparaz, Joseph R.; Gerall, Claire; Griggs, Cornelia L.; Hanna, David N.; He, Katherine; Keane, Olivia A.; McLean, Sean E.; Pace, Elizabeth; Scholz, Stefan; Sferra, Shelby R.; Tracy, Elisabeth T.; Zhang, Lucy; Rangel, Shawn J.
Source
Annals of Surgery. Nov 16, 2023
Subject
Language
English
ISSN
0003-4932
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.