Postoperative Antibiotics for Complicated Appendicitis in Children: Piperacillin/Tazobactam Versus Ceftriaxone with Metronidazole

Zeineddin, Suhail; Pitt, J. Benjamin; Linton, Samuel; DeBoer, Chris; Hu, Andrew; Carter, Michela; Alayleh, Amin; Raval, Mehul V.; Goldstein, Seth D.

doi:10.1016/j.jpedsurg.2023.02.027

Cited by 3 publications

(2 citation statements)

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“…In a retrospective analysis of 29,015 children using the Pediatric Health Information System database, treatment with PT was associated with higher rates of postoperative drainage compared to CM although outcomes were equivalent after adjustment for differences in practice patterns. 23 This analysis was limited in its reliance on administrative data for defining both exposures and outcomes, as well as the inability to adjust for differences in disease severity. This latter limitation has important implications for the interpretation of the data given in the present study patients receiving PT had more severe disease compared to those receiving CM before severity adjustment.…”

Section: Discussionmentioning

confidence: 99%

“…The results of this analysis provide important new insight into the relatively limited pool of multicenter comparative data exploring antibiotic-associated outcomes in children with complicated appendicitis. In a retrospective analysis of 29,015 children using the Pediatric Health Information System database, treatment with PT was associated with higher rates of postoperative drainage compared to CM although outcomes were equivalent after adjustment for differences in practice patterns 23 . This analysis was limited in its reliance on administrative data for defining both exposures and outcomes, as well as the inability to adjust for differences in disease severity.…”

Section: Discussionmentioning

confidence: 99%

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

Cramm,

Graham,

Feng

et al. 2023

Annals of Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%