46 Results after continuous evaluation of antibiotic guidelines in acute appendicitis

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Abstract Introduction The daily reevaluation of the need to continue with postoperative antibiotic treatment in intra-abdominal infection is one of the strategies to reduce antibiotic resistance in our environment, since it avoids the selection of resistant bacterial strains. Thus, limiting the duration of antibiotic treatment is useful to reduce the deleterious effects of antimicrobials on the patient, avoiding adverse effects derived from them. Material and methods An observational, single-center and retrospective study was proposed of the result of not having strict guidelines for postoperative antibiotic duration in the case of intra-abdominal infection of appendiceal origin. Since 2018, when the PROA teams were created, in our center, different measures have been carried out. Two periods 2017–2018 were compared, pre-implementation of the PROA with the years 2021–2022 and 2023. Both in-hospital and at one month, any complication that occurred was recorded through clavien-dindo classification, readmission and the total and postoperative duration of stay, in a base for the entire General Surgery service with an independent data manager and peer review. Also, the patient's age, type of appendicitis with macroscopic and microscopic classification, approach route, total conversion and antibiotic regimens administered were recorded. Results In the first period, 798 patients were included, who presented 19% of adverse effects, among them related to the wound they accounted for 6.5% and intra-abdominal ones (abscesses) for 4.6%. In the second period, 881 patients were included, who presented 18.2% of total adverse effects. Those related to the wound accounted for 4.8% and abscesses for 3.18%. No differences between both periods, P = 0.14 in the case of wounds or intra-abdominal infection P = 0.07. The postoperative hospital stay for all types of acute appendicitis did not vary between periods; it was reduced in the case of phlegmonous appendicitis, which went from 2.4 days to 1.29 days. In 71% of cases, empirical antibiotic treatment was amoxiilicin-clavulanate and cefotaxime + metronidazole in 23% of cases. The greater number of patients with short duration regimens of 1 and/or two days was significant both in appendicitis with peritonitis and in the group described as perforated and gangrenous with [9.8% versus 22%; P = 0.037] and [16% versus 25%; P = 0.04]. Conclusions There has been no increase in readmissions, re-interventions, intra-abdominal abscesses or surgical wound infection. An overall reduction in hospital stay has been achieved. The duration of treatment in complicated acute appendicitis has been significantly reduced. Studies must continue to advance with the characteristics of the patients and the duration of antibiotic treatment must be prospective, as well as reported by dose per day per patient, otherwise it can be overestimated.

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