AS01.d. Antibiotic Stewardship

PD091 - CLINICAL IMPACT AFTER IMPLEMENTATION OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM AND A JOINT ELECTRONIC PROTOCOL FOR THE MANAGEMENT OF PATIENTS WITH APPENDICITIS AND/OR PERITONITIS IN PEDIATRICS (ID 775)

Session Name
0330 - Poster Discussion Session 05: Antimicrobials & Antibiotic Stewardship (ID 6)
Presenter
Authors

Abstract

Backgrounds:

Appendix-related intraabdominal infections are common surgical pathologies in children. Initial antibiotic treatment significantly reduces wound infection and intra-abdominal abscess formation in patients with gangrenous or perforated appendicitis. Randomized controlled trials have shown that the use of lower-spectrum antibiotic combinations is as effective in preventing abscesses or surgical wound infections as broad-spectrum regimens.

Methods

Observational, retrospective study of patients <16 years of age admitted for appendicitis and/or peritonitis from Jan/2014 to Dec/2019 in a tertiary university hospital in Madrid, Spain. Three study periods were established: P1 2014-2015 (before Antimicrobial Stewardship Programme (ASP)), P2 2016-2018 (ASP implemented) and P3 Jan/2019-Dec/2019 (ASP and implementation of a appendicitis/peritonitis protocol with electronic prescribing, including lower-spectrum antibiotic combinations and selected and clinically guided use after surgery). Demographic, clinical and infectious complications after surgery data were collected.

Results:

1619 patients were included. A total of 137 (8.5 %) patients developed infectious complications, with a median of 20.5 infectious complications per period (IQR 19-22.8). The most frequent complication was intra-abdominal abscesses (101/137, 73.7%). In P1, P2 and P3 the rate of intra-abdominal abscesses per period was 7.6%, 9.8% and 6.2% respectively (p=0.573). Regarding the length of hospital stay, the percentage of patients who remained hospitalized for ≤5 days increased during the study periods: 67.6% in P1, 70.7% in P2, and 82.7% in P3 (p<0.001).

Conclusions/Learning Points:

After the implementation of an ASP and a lower-spectrum antibiotic protocol with electronic prescribing and a clinically guided use after surgery, the proportion of infectious complications after surgery for appendicitis/peritonitis remained stable. In parallel, the proportion of patients who were hospitalized for 5 days or less increased in the period with an electronic prescribing tool implemented with the ASP.

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