IMPORTANCE: Optimal duration of antibiotic treatment to reduce infectious complications after an appendectomy for acute complicated appendicitis remains unclear. OBJECTIVE: To investigate the effect of antibiotic duration on infectious complications after laparoscopic appendectomy for acute complicated appendicitis. DESIGN, SETTING, AND PARTICIPANTS: National multicenter prospective, observational, surgical resident-led cohort study conducted in June and July 2014. This study involved academic teaching hospitals (n = 8), community teaching hospitals (n = 38), and community nonteaching hospitals (n = 16), and all consecutive patients (n = 1975) who underwent surgery for suspected acute appendicitis. EXPOSURES: Patients treated laparoscopically for whom the antibiotic regimens were prolonged postoperatively because of complicated appendicitis. MAIN OUTCOMES AND MEASURES: Receiving either 3 or 5 days of antibiotic treatment as planned and additional variables were explored as risk factors for infectious complications using regression analyses. RESULTS: A total of 1975 patients were included in 62 participating Dutch hospitals; 1901 (96.3%) of these underwent an appendectomy for acute appendicitis and laparoscopy was used in 74.4% of these patients (n = 1415). In 415 laparoscopically treated patients, antibiotic treatment was continued for more than 24 hours because of acute complicated appendicitis (29.3%). The prescribed antibiotic duration varied between 2 and 6 days in all of these patients. In 123 patients (29.6%), the length of treatment was adjusted. A shorter duration of antibiotic treatment (3 days instead of 5) had no significant effect on any infectious complication (odds ratio [OR], 0.93; 95% CI, 0.38-2.32; P = .88) or on intra-abdominal abscess development (OR, 0.89; 95% CI, 0.34-2.35; P = .81). Perforation of the appendix was the only independent risk factor for the development of an infectious complication (OR, 4.90; 95% CI, 1.41-17.06; P = .01) and intra-abdominal abscess (OR, 7.46; 95% CI, 1.65-33.66; P = .009) in multivariable regression analysis. CONCLUSIONS AND RELEVANCE: Lengthening of postoperative antibiotic treatment to 5 days was not associated with a reduction in infectious complications. Further restriction of antibiotic treatment can be considered in nonperforated complicated appendicitis.
IMPORTANCE: Optimal duration of antibiotic treatment to reduce infectious complications after an appendectomy for acute complicated appendicitis remains unclear. OBJECTIVE: To investigate the effect of antibiotic duration on infectious complications after laparoscopic appendectomy for acute complicated appendicitis. DESIGN, SETTING, AND PARTICIPANTS: National multicenter prospective, observational, surgical resident-led cohort study conducted in June and July 2014. This study involved academic teaching hospitals (n = 8), community teaching hospitals (n = 38), and community nonteaching hospitals (n = 16), and all consecutive patients (n = 1975) who underwent surgery for suspected acute appendicitis. EXPOSURES: Patients treated laparoscopically for whom the antibiotic regimens were prolonged postoperatively because of complicated appendicitis. MAIN OUTCOMES AND MEASURES: Receiving either 3 or 5 days of antibiotic treatment as planned and additional variables were explored as risk factors for infectious complications using regression analyses. RESULTS: A total of 1975 patients were included in 62 participating Dutch hospitals; 1901 (96.3%) of these underwent an appendectomy for acute appendicitis and laparoscopy was used in 74.4% of these patients (n = 1415). In 415 laparoscopically treated patients, antibiotic treatment was continued for more than 24 hours because of acute complicated appendicitis (29.3%). The prescribed antibiotic duration varied between 2 and 6 days in all of these patients. In 123 patients (29.6%), the length of treatment was adjusted. A shorter duration of antibiotic treatment (3 days instead of 5) had no significant effect on any infectious complication (odds ratio [OR], 0.93; 95% CI, 0.38-2.32; P = .88) or on intra-abdominal abscess development (OR, 0.89; 95% CI, 0.34-2.35; P = .81). Perforation of the appendix was the only independent risk factor for the development of an infectious complication (OR, 4.90; 95% CI, 1.41-17.06; P = .01) and intra-abdominal abscess (OR, 7.46; 95% CI, 1.65-33.66; P = .009) in multivariable regression analysis. CONCLUSIONS AND RELEVANCE: Lengthening of postoperative antibiotic treatment to 5 days was not associated with a reduction in infectious complications. Further restriction of antibiotic treatment can be considered in nonperforated complicated appendicitis.
Authors: Louis J X Giesen; Anne Loes van den Boom; Charles C van Rossem; P T den Hoed; Bas P L Wijnhoven Journal: Dig Surg Date: 2016-09-16 Impact factor: 2.588
Authors: Anastasia Murtha-Lemekhova; Juri Fuchs; Miriam Teroerde; Ute Chiriac; Rosa Klotz; Daniel Hornuss; Jan Larmann; Markus A Weigand; Katrin Hoffmann Journal: Antibiotics (Basel) Date: 2022-05-12
Authors: Frank-Mattias Schäfer; Johannes Meyer; Stephan Kellnar; Jakob Warmbrunn; Tobias Schuster; Stefanie Simon; Thomas Meyer; Julia Platzer; Jochen Hubertus; Sigurd T Seitz; Christian Knorr; Maximilian Stehr Journal: Front Pediatr Date: 2021-05-07 Impact factor: 3.418
Authors: A L van den Boom; E M L de Wijkerslooth; K A L Mauff; I Dawson; C C van Rossem; B R Toorenvliet; B P L Wijnhoven Journal: Br J Surg Date: 2018-04-16 Impact factor: 6.939
Authors: Anne Loes van den Boom; Elisabeth M L de Wijkerslooth; Joost van Rosmalen; Frédérique H Beverdam; Evert-Jan G Boerma; Marja A Boermeester; Joanna W A M Bosmans; Thijs A Burghgraef; Esther C J Consten; Imro Dawson; Jan Willem T Dekker; Marloes Emous; Anna A W van Geloven; Peter M N Y H Go; Luc A Heijnen; Sander A Huisman; Dayanara Jean Pierre; Joske de Jonge; Jurian H Kloeze; Marc A Koopmanschap; Hester R Langeveld; Misha D P Luyer; Damian C Melles; Johan W Mouton; Augustinus P T van der Ploeg; Floris B Poelmann; Jeroen E H Ponten; Charles C van Rossem; Wilhelmina H Schreurs; Joël Shapiro; Pascal Steenvoorde; Boudewijn R Toorenvliet; Joost Verhelst; Hendt P Versteegh; Rene M H Wijnen; Bas P L Wijnhoven Journal: Trials Date: 2018-05-02 Impact factor: 2.279