Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Antibiotic Stewardship in Nonoperative Management of Perforated Appendicitis: Oral Antibiotics Are an Alternative

Version 1 : Received: 5 December 2022 / Approved: 7 December 2022 / Online: 7 December 2022 (02:22:08 CET)

How to cite: Galvis, A. E.; Bucayu, R.; John, R.; Guner MD, Y.; Arrieta, A. C.; Nieves, D. J. Antibiotic Stewardship in Nonoperative Management of Perforated Appendicitis: Oral Antibiotics Are an Alternative. Preprints 2022, 2022120110. https://doi.org/10.20944/preprints202212.0110.v1 Galvis, A. E.; Bucayu, R.; John, R.; Guner MD, Y.; Arrieta, A. C.; Nieves, D. J. Antibiotic Stewardship in Nonoperative Management of Perforated Appendicitis: Oral Antibiotics Are an Alternative. Preprints 2022, 2022120110. https://doi.org/10.20944/preprints202212.0110.v1

Abstract

The standard of care for nonoperative appendicitis patients involves ongoing antibiotic therapy. Yet, there is variability regarding the decision to continue outpatient parenteral antibiotic treatment (OPAT) or transition to oral (PO) antibiotics. Methods: In our single-center retrospective study, we reviewed 46 pediatric patients who underwent nonoperative management of perforated appendicitis with Interventional Radiology (IR) percutaneous drainage. We reviewed age, ethnicity, hospitalization length, antibiotic choice, route and duration, and culture data. Results. Thirty-eight [83%] patients went home on OPAT, 6[13%] on PO, and 2[4%] completed therapy while inpatient. Based on culture susceptibilities of the 38 OPAT patients, 29[76%] had oral antibiotics as an option. The three most common organisms in those sent home on OPAT included Enterococcus faecalis (38 [100%]), Bacteroides spp (33 [87%]) and Escherichia coli (27 [71%]). All patients who grew Pseudomonas aeruginosa had an oral antibiotic as a treatment option; similarly with 93% (25/27) of E. coli, 81% (13/16) of α-hemolytic Streptococcus spp, and 76% (29/38) of Enterococcus faecalis.  Conclusions:  Nearly 80% of patients sent home on OPAT had PO antibiotic regimens options based on the culture susceptibility profiles. This data indicates that using cultures and susceptibility data can help guide antibiotic management, significantly reducing PICC line placement and likely reduce healthcare costs and complications associated with central lines.

Keywords

discharge antibiotics; complicated Appendicitis; nonoperative management; antimicrobial treatment

Subject

Medicine and Pharmacology, Pediatrics, Perinatology and Child Health

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