Back to 2025 Abstracts
POSTOPERATIVE ANTIBIOTICS IN PEDIATRIC PERFORATED APPENDICITIS: COMPARATIVE OUTCOMES WITH MONOTHERAPY VS. MULTI-DRUG COVERAGE
Jaclyn R. Dempsey
*, Aakash Srikanth, Geetha Radhakrishnan, Ravi Radhakrishnan
Surgery, University of Texas Medical Branch, Galveston, TX
Introduction: Perforated appendicitis is common in pediatric patients and carries a high risk of postoperative intraabdominal abscess formation. Therefore, effective postoperative antibiotic regimens are a vital component of treatment. There has been a shift away from traditional triple-drug regimens, including an aminoglycoside, clindamycin, and ampicillin, to a two-drug approach, consisting of a cephalosporin and metronidazole. Previously, controlled studies have indicated that single-agent therapies, such as piperacillin-tazobactam (PT), may reduce complications related to infection in controlled settings, but there is limited real-world data comparing outcomes in patients on PT versus ceftriaxone and metronidazole (CM). This study aims to assess the effectiveness of PT compared to CM in reducing postoperative complications related to perforated appendicitis, particularly abscess formation.
Methods:A retrospective cohort study was conducted using TriNetX, a real-world international federated database containing de-identified electronic medical record data. The database was queried for pediatric patients (ages £18 years) with perforated appendicitis (ICD10 K35.32) who underwent laparoscopic appendectomy (CPT 44970), stratified to compare patients who received PT versus CM in the postoperative period. Cohorts were assessed for 30-day outcomes, including postoperative intraabdominal abscess formation, adverse reactions to antibiotics, need for additional abdominal computed tomography (CT) imaging, emergency department (ED) visits, and hospital readmissions.
Results: A total of 7,739 patients were included, with 4,638 (60%) receiving CM and 3,101 (40%) receiving PT. In comparison to the CM cohort, the PT cohort had significantly higher postoperative intraabdominal abscess formation (13.6% vs 8.5%, p<0.001, OR 1.68) and higher postoperative CT imaging rates (0.90% vs 0.35%, p=0.001, OR 2.63). Patients receiving PT also had more adverse medication reactions (0.5% vs 0.2%, p=0.026, OR 2.40). However, there was no significant difference in ED visits or hospital readmissions between the two cohorts.
Conclusion:In pediatric patients with perforated appendicitis, postoperative CM was associated with a significantly lower risk of postoperative intrabdominal abscess formation, need for additional abdominal CT, and adverse medication reactions compared to those receiving PT. These findings suggest that postoperative dual antibiotic coverage with CM may be superior to monotherapy with PT for children with perforated appendicitis.
Back to 2025 Abstracts
