A simple and more cost-effective antibiotic regimen for perforated appendicitis

2006 ◽  
Vol 41 (5) ◽  
pp. 1020-1024 ◽  
Author(s):  
Shawn D. St. Peter ◽  
Danny C. Little ◽  
Casey M. Calkins ◽  
J. Patrick Murphy ◽  
Walter S. Andrews ◽  
...  
Keyword(s):  
Perforated Appendicitis ◽  
Cost Effective ◽  
Antibiotic Regimen

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

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.

Non-Operative Management is More Cost-Effective than Immediate Operation in Perforated Appendicitis Patients with Seven or More Days of Symptoms

2019 ◽  
Vol 240 ◽  
pp. 70-79
Author(s):  
Mubina A. Isani ◽  
Jeremy Jackson ◽  
Wesley E. Barry ◽  
Michael U. Mallicote ◽  
David Rosenberg ◽  
...  
Keyword(s):  
Perforated Appendicitis ◽  
Cost Effective ◽  
Operative Management ◽  
Non Operative Management

Cost-Effective Approach to the Laparoscopic Appendectomy

2020 ◽  
Vol 86 (6) ◽  
pp. 715-720
Author(s):  
Alexander M. DeMare ◽  
Natalie C. Luehmann ◽  
Samer Kawak ◽  
Emily E. Abbott ◽  
Jordan Long ◽  
...  
Keyword(s):  
Health Care ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Health Care Cost ◽  
Perforated Appendicitis ◽  
Cost Effective ◽  
Cost Effective Approach ◽  
Disposable Instruments ◽  
Improving Health Care ◽  
Median Operative Time

Background Surgeons can help reduce health care spending by selecting affordable and efficient instruments. The laparoscopic appendectomy (LA) is commonly performed and can serve as a model for improving health care cost. Methods We retrospectively reviewed all adult patients who underwent LA for non-perforated appendicitis from March 2015 to November 2017. Our objective was to determine which combination of disposable instruments afforded the lowest total operative cost without compromising postoperative outcomes. Results In total, 1857 consecutive patients were reviewed from 2 hospitals. After determining the 8 most commonly utilized combinations of disposable instruments, 846 patients were ultimately analyzed. The combination of a LigaSure, Endoloop, and an EndoBag (LEB) had the shortest median operative time (25 minutes, P < .001) and lowest median total operative cost ($1893, P < .001). Conclusions The LEB instrument combination rendered the shortest operative time, lowest total operative cost, and can be used to maximize surgical value during LA.

Dual versus Triple Antibiotics Regimen in Children with Perforated Acute Appendicitis

2017 ◽  
Vol 28 (06) ◽  
pp. 491-494 ◽  
Author(s):  
Elad Feigin ◽  
Inbal Samuk ◽  
Dragan Kravarusic ◽  
Artur Baazov ◽  
Itzhak Levy ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Perforated Appendicitis ◽  
Cost Effective ◽  
Dual Therapy ◽  
Wound Infections ◽  
Perforated Appendix ◽  
Group A ◽  
Group B

Introduction Acute appendicitis is the most common emergency condition in pediatric surgery. Historically, a triple-antibiotic therapy consisted of ampicillin, gentamicin, and clindamycin has been used postoperatively for perforated appendicitis. According to recently published trials, dual therapy consists of ceftriaxone and metronidazole only, offers a more efficient and cost-effective antibiotic management compared with triple therapy. Based on these results, our department applied dual antibiotic therapy for children with perforated appendicitis that underwent appendectomy from 2009 and forth. Aim The aim of our study was to compare postoperative outcomes between patients treated with triple therapy (ampicillin, gentamicin, and metronidazole) (group A) versus dual therapy (ceftriaxone and metronidazole) (group B). Methods Clinical and laboratory data were retrospectively collected by review of the medical records for all children who underwent appendectomy for the perforated appendix at the Schneider Children's Medical Center of Israel, a tertiary pediatric care center between 2007 and 2011. Children with perforated appendicitis received antibiotic therapy in accordance with the hospital's guidelines that were valid at the time the surgery took place. In the first period (years 2007–2009) (group A) a triad of ampicillin, gentamicin, and metronidazole and the second period (2009–2011) (group B) dual therapy consists of ceftriaxone and metronidazole. The two groups were compared for outcome and complications, such as wound infections, changing of antibiotic therapy, and length of stay. Results During the study period 1,203 patients underwent an appendectomy. Of these, 175 patients were diagnosed with perforated appendix and were treated with postoperative antibiotic's regimen. Group A and group B consisted of 89 and 86 patients, respectively. The two groups were not different significantly in terms of demographic data, length of stay, or readmission rates. However, more rates of wound infection and changing of antibiotic therapy were seen in group B, although not statistically significant (p = 0.064). Conclusion Dual antibiotic therapy for perforated appendicitis is a cost-effective and efficient mode of therapy compared with triple-antibiotic's regimen. However, prospective studies are required to determine whether this policy is associated with higher rates of wound infections and change in antibiotic therapy.

scholarly journals ULTRASOUND EVALUATION OF NON-PERFORATED AND PERFORATED APPENDICITIS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Armel Arputha Sivarajan ◽  
Raju MVS ◽  
B. Padhmini ◽  
R.S. Jenish
Keyword(s):  
Perforated Appendicitis ◽  
Cost Effective ◽  
Chi Square ◽  
Radiological Investigation ◽  
Ultrasound Evaluation ◽  
Significant Difference ◽  
Chi Square Test ◽  
Patient Preparation ◽  
Average Size ◽  
Study Participants

Background: Ultrasonography (USG) of abdomen remains one of the commonly asked investigations by the surgeon in patients with suspected acute abdomen. The advantage of USG over other radiological investigation is that it is easily available, cost effective, portable, no known side effects, non-invasive and requires minimal patient preparation for carrying out the examination. The present study aimed at evaluating ultrasonography findings of appendicitis and to correlate with operative and histo-pathological findings. Material and Methods: In our study, USG evaluation was done by the investigators for 61 clinically diagnosed patients, so as to achieve 50 radiologically confirmed appendicitis cases which was the required sample. The study was carried out from December 2013 to September 2015. Data was analysed using the statistical software SPSS version 21.0. Chi Square test was applied to test statistically significant difference in proportion. Results: In the present study the mean age the study participants was 26.42 years. Majority of the study participants were males 29 (58%) while females represented 42%.The average size of the appendix among the study participants was observed to be 7.08 mm with a standard deviation of ± 1.07 mm. Among all the study participants with acute appendicitis in our study 22% of the patients had perforation of appendix. In our study, we proved that all USG diagnosed appendicitis cases (100%) were histo-pathologically correct but the variations found in diagnosing the perforation status. We found that the USG had 73.33% and 100% sensitivity and specificity in finding the perforation status.

The application of electron microscopy to diagnosis in gynecologic neoplasms and tumor-like conditions

1984 ◽  
Vol 42 ◽  
pp. 102-105
Author(s):  
Lawrence M. Roth
Keyword(s):  
Electron Microscopy ◽  
Reproductive Tract ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Cost Effective ◽  
Female Reproductive Tract ◽  
Ultrastructural Examination ◽  
Specific Diagnosis ◽  
Potential Value ◽  
Gynecologic Neoplasms

The female reproductive tract may be the site of a wide variety of benign and malignant tumors, as well as non-neoplastic tumor-like conditions, most of which can be diagnosed by light microscopic examination including special stains and more recently immunoperoxidase techniques. Nevertheless there are situations where ultrastructural examination can contribute substantially to an accurate and specific diagnosis. It is my opinion that electron microscopy can be of greatest benefit and is most cost effective when applied in conjunction with other methodologies. Thus, I have developed an approach which has proved useful for me and may have benefit for others. In cases where it is deemed of potential value, glutaraldehyde-fixed material is obtained at the time of frozen section or otherwise at operation. Coordination with the gynecologic oncologist is required in the latter situation. This material is processed and blocked and is available if a future need arises.

Sign in / Sign up

Export Citation Format

Share Document