Redosing Ceftriaxone/Metronidazole for Children Undergoing Laparoscopic Appendectomy for Complicated Appendicitis

Author(s):
Nikitha Garapaty; Monique Motta; Margaret Savage; Maya Kandah; Stephanie Massimilian; Joann Segarra; Ingry Jaramillo; Shenae Samuels; Tamar Levene

Background:

Appendicitis is the most common indication for abdominal surgery among children, and risk of surgical site infection (SSI) increases with more advanced disease leading to increased morbidity and mortality. As such, it is imperative to implement strategies to reduce SSIs while considering appropriate antibiotic utilization. Evaluating differences in outcomes for pediatric patients undergoing laparoscopic appendectomy for complicated appendicitis treated pre-operatively with a single dose of treatment antibiotics versus an additional dose of antibiotics closer to the time of surgery allows for optimization of care.

Hypothesis:

Redosing of pre-operative antibiotics within six hours of laparoscopic appendectomy for complicated appendicitis will decrease SSI rates among pediatric patients.

Methods:

A retrospective chart review was conducted for patients less than 18 years old who underwent a laparoscopic appendectomy for complicated appendicitis from January 2020 – December 2022.  Hospital length of stay along with rates of SSIs, emergency room (ER) visits, office visits, and hospital readmissions were compared for patients who did or did not receive an additional dose of antibiotics within six hours of surgery following initial treatment dose of antibiotics, with results significant at p<0.05.

Results:

Among 217 pediatric patients, 23.5% (n=51) received an additional dose of antibiotics within six hours of incision following an initial treatment dose of Ceftriaxone/Metronidazole, with the remainder receiving only the single treatment dose at the time of diagnosis. There were no statistically significant differences in demographics, baseline characteristics, or outcomes evaluated between the two study groups (Table 1).

Conclusions:

The results suggest that redosing pre-operative antibiotics closer to the time of incision following an initial treatment dose of Ceftriaxone and Metronidazole does not impact SSI rates or outcomes among pediatric patients undergoing laparoscopic appendectomy for complicated appendicitis. Clinical practice guidelines for pre-operative antibiotic utilization in the setting of complicated appendicitis should account for this to decrease unnecessary exposure to additional antibiotics and optimize care.