Variation in anti‐microbial prescription and complications post emergency appendicectomy in Australia: do we follow recommended guidelines?

Abstract

Background This study aims to establish compliance levels to prescription guidelines among Australian surgeons in the use of antibiotics in the surgical management of appendicitis. The secondary outcomes are predictors of post‐operative infective complications; surgical site infection (SSI) and intra‐abdominal abscess (IAA) at 30 days. Methods A multi‐centre, prospective, observational study was conducted over a period of 2 months with a 30‐day follow‐up. Patients were eligible for recruitment if they underwent appendicectomy for suspected appendicitis. Antibiotics prescription practices were recorded and compared to national guidelines. Results A total of 1189 patients were recruited across 27 centres; 1081 (92.1%) patients were given prophylactic antibiotics at the time of appendicectomy. Patients with gangrenous appendicitis were more likely to receive prophylactic antibiotics (98.9%); lower rates of use were seen in the non‐appendicitis group (85.7%). A total of 619 (53.3%) patients received antibiotics in the post‐operative period. Despite recommendations, 300 (44.3%) patients with simple appendicitis received post‐operative antibiotics. Only six (2.9%) patients with complicated appendicitis did not receive antibiotics. Overall, SSI and IAA rates were 1.9% and 2.7%, respectively. Aboriginal and Torres Strait Islanders (P = 0.02) and patients with converted operations (P = 0.001) were more likely to have a SSI. Patients with complicated appendicitis and those operated on by a consultant were more likely to increase the odds of IAA (odds ratio 3.8 and 5.1, respectively). Conclusion This broad‐based study shows mixed compliance with antibiotic guidelines in the surgical management of appendicitis in Australia. The use of post‐operative antibiotics in patients with simple appendicitis should be a target for antimicrobial stewardship programmes to prevent antibiotic over‐utilization.

What controls microzooplankton biomass and herbivory rate across marginal seas of China?

“…where c is the coefficient and γ is the dimensionless scaling exponent; B z (μg C L −1 ) is the carbon biomass of total microzooplankton; P (μg C L −1 ) is the phytoplankton carbon biomass converted by multiplying the Chl a concentration by the model-derived carbon-to-chlorophyll ratio (C : Chl, gC gChl −1 ). The C : Chl ratio was estimated using a Boosted Regression Trees model (Elith and Leathwick 2017) which was constructed based on a published data set consisted of C : Chl ratio, light, temperature, and dissolved inorganic nitrogen (Chen and Liu 2010). In this model, the C : Chl ratio is a function of temperature, nutrient, and light (Supporting Information).…”

Antimicrobial resistance and antibiotic usage: what can surgeons do?

“…In this issue, Thong et al . have done a prospective multi‐centre study over a 2‐month period, looking at the perioperative use of antibiotics in the management of acute appendicitis.…”

Measuring the quality of surgical care provision to Aboriginal and Torres Strait Islander patients

“…A recent publication by Thong et al . examined the variation in antibiotic prescription and complications for emergency appendicectomy in Australia . Antibiotic prophylaxis was provided to 92% of all patients.…”

“…A recent publication by Thong et al examined the variation in antibiotic prescription and complications for emergency appendicectomy in Australia. 10 Antibiotic prophylaxis was provided to 92% of all patients. Aboriginal and/or Torres Strait Islander patients were 5.8 times more likely to develop an SSI compared to other patients.…”

“…Aboriginal and Torres Strait Islander patients have a higher emergency to elective surgery ratio, a global indicator of access to surgical care . When Aboriginal and/or Torres Strait Islander Australians do access surgical care, they may experience higher rates of post‐operative morbidity and mortality . The focus must now shift from simply reporting disparities in surgical outcomes for Aboriginal and/or Torres Strait Islander Australians to identifying, measuring and addressing the process measures involved in these poor surgical outcomes.…”