Lack of benefit of preoperative antimicrobial prophylaxis in children with acute appendicitis: a prospective cohort study
Tóm tắt
Preoperative antimicrobial prophylaxis is widely used in pediatric patients undergoing appendectomy, but evidence showing a reduction of postoperative infectious complications is lacking. A prospective consecutive cohort study on changing from preoperative antimicrobial prophylaxis to no prophylaxis in children undergoing urgent appendectomy was undertaken. The impact of this change in management on postoperative infectious complications was evaluated by comparing the outcome in 100 patients receiving (group A) and a subsequent 100 patients not receiving prophylaxis (group B), which consisted of a preoperative single dose of intravenous metronidazole (10 mg/kg body weight). Histology confirmed acute appendicitis in 92 patients of group A and 95 patients of group B. In patients with histological simple appendicitis, postoperative infectious complications were noted in 2 (3.0 %) of 69 patients from group A and in none of 70 patients from group B, and in patients with histological perforated appendicitis in 5 (22 %) of 23 and 4 (16 %) of 25 patients from groups A and B, respectively. Postoperative infectious complications were more frequent (p < 0.05) in perforated than in simple appendicitis. These infectious complications included in simple appendicitis two wound infections in group A, and in perforated appendicitis four intraabdominal abscesses and one wound infection in group A and two intraabdominal abscesses and two wound infections in group B. Postoperative infectious complications were seen more often in patients with perforated appendicitis than in those with simple appendicitis. Preoperative antimicrobial prophylaxis with metronidazole did not reduce the rates of postoperative infectious complications.
Tài liệu tham khảo
Bratton SL, Haberkern CM, Waldhausen JH. Acute appendicitis risks of complications: age and Medicaid insurance. Pediatrics. 2000;106:75–8.
Körner H, Söreide JA, Pedersen EJ, Bru T, Söndenaa K, Vatten L. Stability in incidence of acute appendicitis. A population-based longitudinal study. Dig Surg. 2001;18:61–6.
Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH. Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg. 1997;21:313–7.
Andersson R, Hugander A, Thulin A, Nyström PO, Olaison G. Indications for operation in suspected appendicitis and incidence of perforation. BMJ. 1994;308:107–10.
Hoelzer DJ, Zabel DD, Zern JT. Determining duration of antibiotic use in children with complicated appendicitis. Pediatr Infect Dis J. 1999;18:979–82.
Pearl RH, Hale DA, Molloy M, Schutt DC, Jaques DP. Pediatric appendectomy. J Pediatr Surg. 1995;30:173–8.
Fishman SJ, Pelosi L, Klavon SL, O’Rourke EJ. Perforated appendicitis: prospective outcome analysis for 150 children. J Pediatr Surg. 2000;35:923–6.
Emil S, Laberge JM, Mikhail P, Baican L, Flageole H, Nguyen L, Shaw K. Appendicitis in children: a ten-year update of therapeutic recommendations. J Pediatr Surg. 2003;38:236–42.
Muehlstedt SG, Pham TQ, Schmeling DJ. The management of pediatric appendicitis: a survey of North American Pediatric Surgeons. J Pediatr Surg. 2004;39:875–9.
Friedell ML, Perez-Izquierdo M. Is there a role for interval appendectomy in the management of acute appendicitis? Am Surg. 2000;66:1158–62.
Giacomantonio M, Bortolussi R, Gillis DA. Should prophylactic antibiotics be given perioperatively in acute appendicitis without perforation? Can J Surg. 1982;25:555–6.
Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg. 2007;245:886–92.
Bufo AJ, Shah RS, Li MH, Cyr NA, Hollabaugh RS, Hixson SD, Schropp KP, Lasater OE, Joyner RE, Lobe TE. Interval appendectomy for perforated appendicitis in children. J Laparoendosc Adv Surg Tech A. 1998;8:209–14.
Oliak D, Yamini D, Udani VM, Lewis RJ, Vargas H, Arnell T, Stamos MJ. Nonoperative management of perforated appendicitis without periappendiceal mass. Am J Surg. 2000;179:177–81.
Aprahamian CJ, Barnhart DC, Bledsoe SE, Vaid Y, Harmon CM. Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences. J Pediatr Surg. 2007;42:934–8.
Emil S, Duong S. Antibiotic therapy and interval appendectomy for perforated appendicitis in children: a selective approach. Am Surg. 2007;73:917–22.
Puapong D, Lee SL, Haigh PI, Kaminski A, Liu IL, Applebaum H. Routine interval appendectomy in children is not indicated. J Pediatr Surg. 2007;42:1500–3.
Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE Jr, Sweet RL, Wenzel RP. Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis. 1994;18:422–7.
[Anonymous]. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. American Society of Health-System Pharmacists. Am J Health Syst Pharm. 1999;56:1839–88.
Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev. 2005;CD001439.
Kizilcan F, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. The necessity of prophylactic antibiotics in uncomplicated appendicitis during childhood. J Pediatr Surg. 1992;27:586–8.
Söderquist-Elinder C, Hirsch K, Bergdahl S, Rutqvist J, Frenckner B. Prophylactic antibiotics in uncomplicated appendicitis during childhood—a prospective randomised study. Eur J Pediatr Surg. 1995;5:282–5.
Górecki WJ, Grochowski JA. Are antibiotics necessary in nonperforated appendicitis in children? A double blind randomized controlled trial. Med Sci Monit. 2001;7:289–92.
American Academy of Pediatrics. Section 5: antimicrobial prophylaxis. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Red book: 2009 report of the Committee on Infectious Diseases, 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009. p. 821–823.
Campbell WB. Prophylaxis of infection after appendicectomy: a survey of current surgical practice. Br Med J. 1980;281:1597–600.
Willis AT, Ferguson IR, Jones PH, Phillips KD, Tearle PV, Berry RB, Fiddian RV, Graham DF, Harland DH, Innes DB, Mee WM, Rothwell-Jackson RL, Sutch I, Kilbey C, Edwards D. Metronidazole in prevention and treatment of bacteroides infections after appendicectomy. Br Med J. 1976;1:318–21.
Greenall MJ, Bakran A, Pickford IR, Bradley JA, Halsall A, Macfie J, Odell M, Cooke EM, Lincoln C, McMahon MJ. A double-blind trial of a single intravenous dose of metronidazole as prophylaxis against wound infection following appendicectomy. Br J Surg. 1979;66:428–9.
Gottrup F. Prophylactic metronidazole in prevention of infection after appendicectomy: report of a double-blind trial. Acta Chir Scand. 1980;146:133–6.
Foo FJ, Beckingham IJ, Ahmed I. Intra-operative culture swabs in acute appendicitis: a waste of resources. Surgeon. 2008;6:278–81.
Bilik R, Burnweit C, Shandling B. Is abdominal cavity culture of any value in appendicitis? Am J Surg. 1998;175:267–70.
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606–8.
Bauer T, Vennits B, Holm B, Hahn-Pedersen J, Lysen D, Galatius H, Kristensen ES, Graversen P, Wilhelmsen F, Skjoldborg H, Malmfred S, Villadsen J, Bendix J. Antibiotic prophylaxis in acute nonperforated appendicitis. The Danish Multicenter Study Group III. Ann Surg. 1989;209:307–11.
Marusch F, Koch A, Schmidt U, Zippel R, Lehmann M, Czarnetzki HD, Knoop M, Geissler S, Pross M, Gastinger I, Lippert H. Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study. Int J Colorectal Dis. 2001;16:362–9.
Cappendijk VC, Hazebroek FW. The impact of diagnostic delay on the course of acute appendicitis. Arch Dis Child. 2000;83:64–6.
Luckmann R. Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age. Am J Epidemiol. 1989;129:905–18.
Helmer KS, Robinson EK, Lally KP, Vasquez JC, Kwong KL, Liu TH, Mercer DW. Standardized patient care guidelines reduce infectious morbidity in appendectomy patients. Am J Surg. 2002;183:608–13.
St Peter SD, Little DC, Calkins CM, Murphy JP, Andrews WS, Holcomb GW 3rd, Sharp RJ, Snyder CL, Ostlie DJ. A simple and more cost-effective antibiotic regimen for perforated appendicitis. J Pediatr Surg. 2006;41:1020–4.
Lund DP, Murphy EU. Management of perforated appendicitis in children: a decade of aggressive treatment. J Pediatr Surg. 1994;29:1130–3.
Tönz M, Schmid P, Kaiser G. Antibiotic prophylaxis for appendectomy in children: critical appraisal. World J Surg. 2000;24:995–8.
Ein SH, Sandler A. Wound infection prophylaxis in pediatric acute appendicitis: a 26-year prospective study. J Pediatr Surg. 2006;41:538–41.
St Peter SD, Sharp SW, Holcomb GW 3rd, Ostlie DJ. An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg 2008;43:2242–5.
Newman K, Ponsky T, Kittle K, Dyk L, Throop C, Gieseker K, Sills M, Gilbert J. Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg. 2003;38:372–9.