895. Comparing Antibiotic Durations in Acute Appendicitis After Source Control

Abstract

Abstract Background Community-acquired acute appendicitis is a common intra-abdominal infection that often requires surgical intervention and antibiotics. Despite guideline recommendations for narrow-spectrum regimens and shorter durations, broad-spectrum agents are frequently used for extended durations in community-acquired cases of appendicitis. Methods We conducted a retrospective chart review of 95 adult patients admitted to a community hospital in rural northern Michigan with acute appendicitis with or without perforation who underwent source control and received at least 72 hours of antibiotics after source control. Patients were assigned to a short course group (4-7 days) or a long course group (≥ 8 days). Total antibiotics is the sum of the inpatient duration and outpatient duration after source control. The primary outcome was hospital readmission within 30 days of discharge due to complications related to appendectomy or antibiotic failure. Secondary outcomes included hospital mortality, surgical site infection within 30 days, additional source control needed during initial stay, number of patients receiving piperacillin-tazobactam, and proportion of patients who received guideline concordant duration of therapy. Baseline characteristics between treatment groups Results The primary outcome was met in 1/32 patients (3.13%) from the 4–7 day group and 4/63patients (6.35%) in the ≥8-day group (P = 0.66). There were no cases of mortality. Surgical site infection occurred in 1/63 patients (1.6%) in the ≥8-day group (P = 1). Additional source control was needed in 1/32 patients (3.13%) from the 4-7 day group and 3/63 patients (4.76%) in the ≥ 8 day group (P = 1). Piperacillin-tazobactam was prescribed to 21/32 patients (65.6%) in the 4-7-day group and 42/63 patients (67%) in the ≥ 8day group (P =0.91) Piperacillin-tazobactam was appropriately used in 1/21 patient (4.76%) in the 4-7 day group and 6/42 patients (9.5%) in the ≥ 8 day group (P = 0.41). Outcomes Results of the primary outcome and the piperacillin/tazobactam based secondary outcomes Treatment Duration Between Groups Comparison of total treatment duration between groups with inpatient and outpatient averages Total Antibiotic Duration Frequency Distribution of total antibiotic days of patients analyzed in this study Conclusion In patients with community-acquired acute appendicitis with or without perforation who had undergone adequate source control, outcomes were similar between a 4-7 day course of antibiotics and ≥ 8 day course. Piperacillin-tazobactam was often prescribed for community-acquired appendicitis cases despite guideline recommendations. Disclosures All Authors: No reported disclosures.