Results of a Pilot Trial Comparing Prolonged Intravenous Antibiotics With Sequential Intravenous/Oral Antibiotics for Children With Perforated Appendicitis

Abstract Purpose: Our aim was to investigate the clinical efficacy and complications of antibiotics treatment duration for the patients of bone infection. Methods: We retrospectively analyzed the patients with bone infection admitted to our hospital between March 2013 and October 2018. The surgical debridement was performed and the patients were divided into three groups: IV group (Intravenous antibiotics for 2 weeks); Oral group (Intravenous antibiotics for 2 weeks followed by oral antibiotics for 4 weeks); Rifampicin group (Intravenous antibiotics for 2 weeks followed by oral antibiotics plus rifampicin for 4 weeks). The infection control rate and complications were compared. Results ： A total of 902 patients were enrolled, the infection sites included 509 tibias, 228 femurs, 32 humeri, 23 radii and ulnae, 40 calcanei, 23 multiple-site infections and the other sites 47 cases. After at least 6 months of follow-up, 148 (16.4%) patients had recurrence of infection. The recurrence rate of IV group was 17.9%, which was no significant higher than that of Oral group (10.1%) or Rifampicin group (10.5%). The abnormal rate of Glutamic-pyruvic transaminase(ALT) in IV group was 15.1%, which was lower than that of Oral group (18.0%) and Rifampicin group (27.4%), P=0.026. The positive rates of proteinuria in the three groups were 3.2%, 4.5%, and 9.3%, respectively, P=0.020. Conclusion: After debridement of bone infection, the additional oral antibiotic treatment may increase the damage of liver and kidney, and can not significantly reduce the infection recurrence rate. Therefore, it is recommended to adopt short-term systemic antibiotic treatment after debridement.

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1521. Evaluation of the Microbiology of Intraabdominal Infections in Children and Implications for Treatment and Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1385 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S554-S554

Author(s):

Tibisay I Villalobos-Fry ◽

Mahlon Schaffer ◽

Kristin H Wheatley

Keyword(s):

Perforated Appendicitis ◽

Retrospective Chart Review ◽

Empiric Antibiotic Therapy ◽

Preoperative Treatment ◽

Oral Antibiotics ◽

Antibiotic Regimen ◽

Single Organism ◽

Empiric Antibiotic ◽

Amoxicillin Clavulanate ◽

Fluid Collections

Abstract Background Acute appendicitis is the most common surgical emergency in pediatric medicine. Pseudomonas aeruginosa has been reported in up to 23% of intraoperative cultures though current recommendations do not specify the need for antipseudomonal coverage for preoperative treatment. Prior to transitioning the empiric antibiotic regimen used in the management of perforated appendicitis from an antipseudomonal agent to a simplified daily antibiotic regimen, we conducted a retrospective review of bacterial cultures obtained from intraabdominal fluid collections and antibiotic regimens in children that underwent surgical treatment of perforated appendicitis and/or intraabdominal abscesses. Methods A retrospective chart review of electronic medical records was conducted for pediatric patients admitted with a diagnosis of perforated appendicitis and/or intraabdominal abscess between April 1, 2016 and April 30, 2018. Results Seventy-two patients met inclusion criteria for the study with abscess identified prior to surgery in 11 patients (42.3%). Intraabdominal cultures were obtained in 48 patients (66.7%). The predominant organisms isolated were Escherichia coli, Bacteroides fragilis, and alpha-hemolytic Streptococcus. P. aeruginosa was identified in 12 (24%) cultures and never as a single organism. The majority of patients received piperacillin/tazobactam empirically (91.7%) with a median duration of 5 days (IQR 2). Forty-four patients (61.1%) received oral antibiotics to continue therapy after discharge and 75% received amoxicillin/clavulanate. Of the 12 patients with P. aeruginosa isolated, all patients received piperacillin/tazobactam empirically and 8 (66.7%) were transitioned to oral antibiotics to complete therapy, of which only two regimens retained antipseudomonal coverage. Conclusion Majority of intraabdominal cultures were polymicrobial and the isolation of P. aeruginosa did not appear to impact the choice of definitive antimicrobial therapy. The predominant organisms identified suggest that a non-antipseudomonal regimen (i.e., cephalosporin with metronidazole) may be considered for empiric antibiotic therapy for cases of perforated appendicitis. Disclosures All authors: No reported disclosures.

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EP.TH.965Use of Oral Antibiotics as Adjunct to Systemic Antibiotics and Mechanical Bowel Preparation for Left Sided Colorectal Surgery. It is the time to trust the best available evidence and change the practice

British Journal of Surgery ◽

10.1093/bjs/znab309.100 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahin Hajibandeh ◽

Shahab Hajibandeh ◽

Christopher Thompson ◽

Vijay Thumbe ◽

Andrew Torrance ◽

...

Keyword(s):

Colorectal Surgery ◽

Anastomotic Leak ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Surgical Site Infections ◽

Oral Antibiotics ◽

Intravenous Antibiotics ◽

Clinically Significant ◽

The Uk ◽

Systemic Antibiotics

Abstract Aims To prospectively evaluate the clinical efficacy of oral antibiotics as an adjunct to intravenous antibiotics and mechanical bowel preparation (MBP) in patients undergoing left sided colorectal surgery. Methods All participants aged 18 years or older and of any gender undergoing an elective open or laparoscopic left sided colorectal resection for benign or malignant colorectal pathologies were considered. The intervention of interest was oral neomycin 1g every 4 hours combined with oral metronidazole 400mg every 8 hours from 24 hours before the proposed surgery. Surgical site infections (SSIs), anastomotic leak, paralytic ileus, need for intervention, and mortality were the evaluated outcome parameters. Results Forty-two consecutive patients received oral antibiotics as an adjunct to intravenous antibiotics and MBP before left sided colorectal surgery. The mean age was 58.8 ± 11.5. There were 23 males (54.8%) and 19 females (45.2%). Use of oral antibiotics was associated with SSI infection rate of 2.4% (1 patient). The rates of clinically significant and non-significant anastomotic leak were 0% and 2.9%, respectively. Moreover, postoperative ileus happened in 11.9% of patients. Furthermore, there was no mortality or need for re-intervention. Conclusions Use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in patients undergoing left-sided colorectal surgery was associated with a surprisingly low rate of SSIs and no significant anastomotic leak. It is time to trust the best available evidence and incorporate the use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in colorectal surgery protocols in the UK hospitals.

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Comparative Effectiveness Of Intravenous Versus Oral Antibiotics for Post-Discharge Treatment of Perforated Appendicitis in Children

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.1481 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Lori Handy ◽

Rana F. Hamdy ◽

Matthew Bryan ◽

Daniele Dona ◽

Evangelos Spyridakis ◽

...

Keyword(s):

Comparative Effectiveness ◽

Perforated Appendicitis ◽

Oral Antibiotics ◽

Post Discharge ◽

Discharge Treatment

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Usefulness of Preoperative Mechanical Bowel Preparation in Patients with Colon Cancer who Undergo Elective Surgery: A Prospective Randomized Trial Using Oral Antibiotics

Digestive Surgery ◽

10.1159/000500020 ◽

2019 ◽

Vol 37 (3) ◽

pp. 192-198 ◽

Cited By ~ 2

Author(s):

Toshiyuki Suzuki ◽

Sotaro Sadahiro ◽

Akira Tanaka ◽

Kazutake Okada ◽

Gota Saito ◽

...

Keyword(s):

Colon Cancer ◽

Bowel Preparation ◽

Elective Surgery ◽

Mechanical Bowel Preparation ◽

Infectious Complications ◽

Oral Antibiotic ◽

Oral Antibiotics ◽

Intravenous Antibiotics ◽

Colon Cancer Surgery ◽

To Receive

Background: To prevent surgical site infection (SSI) in colorectal surgery, the combination of mechanical bowel preparation (MBP), oral antibiotic bowel preparation (OABP), and the intravenous antibiotics have been proposed as standard treatment. We conducted an RCT comparing the incidence of SSI between MBP + OABP and OABP alone after receiving a single dose of intravenous antibiotics. Methods: The study group comprised 254 patients who underwent elective surgery for colon cancer. Patients were randomly assigned to receive MBP + OABP and intravenous antibiotics (MBP + OABP group) or to receive OABP and intravenous antibiotics (OABP alone group). Results: Overall, 125 patients in MBP + OABP group and 126 patients in OABP alone group were eligible. Incisional SSI occurred in 3 patients (2.4%) in MBP + OABP group, and 8 patients (6.3%) in the OABP-alone group. Organ/space SSI developed in 0 patients (0%) and in 4 patients (3.2%) in each group respectively. The OABP-alone group was thus not shown to be noninferior to the MBP + OABP group in the incidences of incisional SSI or organ/space SSI. Other infectious complications developed in 7 patients (5.6%) and in 6 patients (4.8%) in each group, indicating the non-inferiority of OABP alone to MBP + OABP. Conclusions: MBP combined with oral antibiotics and intravenous antibiotics remains standard in elective colon cancer surgery.

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