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Enteral Antibiotics are Non-inferior to Intravenous Antibiotics After Complicated Appendicitis in Adults: A Retrospective Multicentre Non-inferiority Study

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Abstract

Background

Prolonging post-operative antibiotic treatment beyond 3 days does not seem to reduce the incidence of post-operative abscess formation or wound infection after surgery for complicated appendicitis. The route of administration seems to be based on an empirical basis. Using enteral antibiotics could reduce length of stay and reduce overall costs. We aimed to examine whether treatment with enteral antibiotics during the first three post-operative days is non-inferior to intravenous antibiotics regarding intra-abdominal abscess formation or wound infection after surgery for complicated appendicitis.

Methods

A retrospective study of adult patients having surgery for complicated appendicitis within a period of 32 months in the Capital Region of Denmark. Primary outcome was the incidence of post-operative abscess formation, and secondary outcome was wound infections, both within 30 days of surgery. Route of antibiotic administration for the first three post-operative days was registered for all patients.

Results

A total of 1141 patients were included in the study. The overall risk of developing an intra-abdominal abscess was 6.7% (95% CI 5.2%; 8.1%), and the risk of wound infection was 1.2% (95% CI 0.6%; 1.8%). In a multivariate intention-to-treat analysis, patients treated post-operatively with enteral antibiotics had an odds ratio of 0.78 (95% CI 0.41; 1.45, p = 0.429) for developing an intra-abdominal abscess and an odds ratio of 0.86 (95% CI 0.17; 4.29, p = 0.851) for developing a wound infection compared to patients treated post-operatively with intravenous antibiotics.

Conclusion

Treatment with enteral antibiotics was non-inferior compared to treatment with intravenous antibiotics during the first 3 days after surgery for complicated appendicitis.

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Funding

The primary author received a research grant from Nordsjællands Hospital and financial support from the Department of Surgery, Nordsjællands Hospital, Copenhagen University Hospital.

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Authors and Affiliations

  1. Department of Surgery, Nordsjællands Hospital, Copenhagen University Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark

    Jakob Kleif & Helle Lund

  2. Gastro Unit, Surgical Division, Hvidovre Hospital, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark

    Louise Rasmussen

  3. Center for Perioperative Optimization, Herlev and Gentofte Hospitals, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark

    Siv Fonnes

  4. Digestive Disease Center, Bispebjerg Hospital, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400, København NV, Denmark

    Pernille Tibæk

  5. Faculty of Health and Medical Science, Copenhagen University, Blegdamsvej 3B, 2200, København N, Denmark

    Alaa Daoud

  6. Center for Surgical Science, Department of Surgery, Zealand University Hospital, Copenhagen University, Lykkebækvej 1, 4600, Køge, Denmark

    Ismail Gögenur

Authors
  1. Jakob Kleif
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  2. Louise Rasmussen
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  3. Siv Fonnes
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  4. Pernille Tibæk
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  5. Alaa Daoud
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  6. Helle Lund
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  7. Ismail Gögenur
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Corresponding author

Correspondence to Jakob Kleif.

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The authors declare that they have no competing interests.

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Kleif, J., Rasmussen, L., Fonnes, S. et al. Enteral Antibiotics are Non-inferior to Intravenous Antibiotics After Complicated Appendicitis in Adults: A Retrospective Multicentre Non-inferiority Study. World J Surg 41, 2706–2714 (2017). https://doi.org/10.1007/s00268-017-4076-6

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  • DOI: https://doi.org/10.1007/s00268-017-4076-6

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