[Fast track antibiotic protocol in acute appendicitis].
BACKGROUND
The increase of antimicrobial resistances, has affected the efficacy of antimicrobial triple therapy, increasing appendicitis morbidity. We decided to change to a fast-track protocol of 72 hours of Cefuroxime-Metronidazol or Ertapenem.


OBJECTIVE
to know if our infectious morbidity rate has improved and if early dischargement is possible.


METHODS
Analytic historic cohort study: Historical cohort (HC): patients intervened of appendicitis between October 2005 and October 2006. Current cohort (CC): started in June 2007. A data collection protocol is designed for both groups. Homogeneity among cohorts is proved and data are analysed (a=0,05). Statistics are analyzed by SPSS 15.0.


RESULTS
226 patients were controlled, being 110 complicated appendicitis (HC: 61/135; AC: 49/91). There are no differences among cohorts about evolution time, temperature and leukocytes rate at admission, interval to intervention, use of laparoscopy, drainage or antimicrobial prophylaxis. There is difference about the use of pre-surgical ultrasound. Admission rate has been reduced in 2.82 days, from 8.41 days in HC to 5.58 with the new antimicrobial protocol (median 7 to 4). The relative risk of developing intraabdominal abscess is 0.366 (HC: 15.7%; CC: 6.4%) (p=0.145) and readmission rate has been reduced from 9.8% to 0% (p=0.028). In 33% of cultures we have found different levels of antimicrobial resistance. No Enterococcus has been isolated.


CONCLUSIONS
1) Infectious morbidity rate has decreased with the new therapy. 2) Antimicrobial resistance and new antibiotics have exceeded Triple antimicrobial therapy. 3) It is possible an early dischargement in perforated appendicitis without an increasing of readmission rate. 4) We must know the bacterial flora in order to adapt our antibiotic therapy.
Limousin
I Tuduri
IT
Servicio de Cirugía Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla. tuduri@yahoo.com
Azcárate
J Morcillo
JM
Cendón
R Granero
RG
Fernández Pineda
I
I
Salinas
D Aspiazu
DA
Laureano
R Cabello
RC
Asensio
J C De Agustín
JC
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy; D001064:Appendicitis / Q000382:microbiology* / Q000601:surgery*; D001424:Bacterial Infections / Q000517:prevention & control*; D002648:Child; D002985:Clinical Protocols; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies
D000900:Anti-Bacterial Agents