Bielicki, I; Schmid, H; Atkinson, A; Kahlert, CR; Berger, C; Troillet, N; Marschall, J; Bielicki, JA; Swissnoso
(2023)
Association between perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in paediatric uncomplicated appendectomy: a Swiss retrospective cohort study.
Antimicrob Resist Infect Control, 12 (1).
p. 106.
ISSN 2047-2994
https://doi.org/10.1186/s13756-023-01312-1
SGUL Authors: Bielicki, Julia Anna
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Abstract
OBJECTIVE: We aimed to evaluate the association between post-appendectomy SSI rates and the two most commonly used regimens for perioperative antimicrobial prophylaxis in Swiss children. METHODS: We conducted a retrospective cohort study, analysing data from the Swiss national SSI surveillance database with a study period from 2014 to 2018. All hospitals undertaking paediatric appendectomies in Switzerland participate in the surveillance. We compared the cumulative incidence and odds of post-appendectomy SSI within 30 days of surgery in children ≤ 16 years of age undergoing appendectomy for uncomplicated appendicitis and receiving perioperative antimicrobial prophylaxis with cefuroxime plus metronidazole or with amoxicillin/clavulanic acid using multivariable adjusted logistic regression and propensity-score matching. RESULTS: A total of 6207 cases were recorded in the study time frame. Overall SSI cumulative incidence was 1.9% (n = 119). 4256 children (54.9% male, median (IQR) age 12 [10, 14] years) received either cefuroxime plus metronidazole (n = 2348, 53.8% male) or amoxicillin/clavulanic acid (n = 1491, 57.0% male). SSI cumulative incidence was 1.1% (25/2348) among children receiving cefuroxime plus metronidazole and 2.8% (42/1491, p < 0.001) when receiving amoxicillin/clavulanic acid. The administration of cefuroxime plus metronidazole was associated with statistically significantly lower SSI odds compared to amoxicillin/clavulanic acid (aOR 0.35, 95%CI [0.20, 0.61], p < 0.001), and this was confirmed upon propensity-score matching. CONCLUSION: We found lower odds of post-appendectomy SSI in children receiving cefuroxime plus metronidazole compared to amoxicillin/clavulanic acid. Treating amoxicillin/clavulanic acid as the baseline, only 55 children need to receive cefuroxime plus metronidazole perioperative prophylaxis to avert one SSI. Existing guidelines recommending amoxicillin/clavulanic acid may need to be revised. Trial registration ISRCTN47727811, registered retrospectively.
| Item Type: | Article | |||||||||
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| Additional Information: | © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. | |||||||||
| Keywords: | Appendectomy, Comparative effectiveness analysis, Paediatric surgery, Perioperative antimicrobial prophylaxis, Surgical site infection, Switzerland, Child, Male, Humans, Female, Surgical Wound Infection, Metronidazole, Cefuroxime, Appendectomy, Retrospective Studies, Switzerland, Amoxicillin-Potassium Clavulanate Combination, Swissnoso, Humans, Surgical Wound Infection, Cefuroxime, Amoxicillin-Potassium Clavulanate Combination, Metronidazole, Appendectomy, Retrospective Studies, Child, Switzerland, Female, Male, Perioperative antimicrobial prophylaxis, Surgical site infection, Paediatric surgery, Appendectomy, Comparative effectiveness analysis, Switzerland, 0605 Microbiology, 1103 Clinical Sciences, 1108 Medical Microbiology | |||||||||
| SGUL Research Institute / Research Centre: | Academic Structure > Infection and Immunity Research Institute (INII) | |||||||||
| Journal or Publication Title: | Antimicrob Resist Infect Control | |||||||||
| ISSN: | 2047-2994 | |||||||||
| Language: | eng | |||||||||
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| Publisher License: | Creative Commons: Attribution 4.0 | |||||||||
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| PubMed ID: | 37749585 | |||||||||
| Web of Science ID: | WOS:001075923900001 | |||||||||
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| URI: | https://openaccess.sgul.ac.uk/id/eprint/115882 | |||||||||
| Publisher's version: | https://doi.org/10.1186/s13756-023-01312-1 |
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