Correlation of surgical site infection with empirical antibiotic therapy in children with perforated appendicitis

Abstract

Surgical site infection (SSI) is one of the possible complications after the surgery of perforated appendicitis (PA) in children. This problem could occur due to the use of inappropriate empirical antibiotics. Evaluating the correlation between empirical antibiotics and surgical site infection could benefit patient care. This was an observational analytic study. We included patients aged less than 18 years old who were diagnosed with PA and treated at Dr. Soetomo General Hospital, Surabaya, from March to July 2020. The patients were given cefuroxime and metronidazole as empirical antibiotics. Appendix tissue and pus samples were taken during the surgery and submitted for microbiology tests. Patients were observed for 30 days post-surgery to examine the occurrence of SSI. Data were taken from the medical records and the correlations with the incidence of SSI were analyzed with Pearson or Spearman correlation tests. Thirty patients were included in this study. Four patients developed superficial incisional SSI and two patients developed organ SSI. No significant relationship between empirical antibiotic therapy with the incidence of SSI was found (p = 0.129). Further analysis also found no significant relationship between sex (p = 0.680), age (p = 0.713), nutritional status (p = 0.645), culture result (p = 0.384), or surgery waiting time (p = 0.13) with the incidence of SSI. However, we found a significant relationship between surgery duration and the incidence of SSI (p = 0.004). Patients with surgery duration > 120 minutes had a 19-fold risk of developing SSI (OR = 19). There was no correlation between the empirical antibiotic type and the incidence of SSI. On the other hand, surgery duration was significantly related to the incidence of SSI.