How can the surgeon choose preoperatively the most appropriate antibiotic prophylaxis vs therapy in pediatric acute appendicitis?
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In brief
In brief
This retrospective study of 120 pediatric appendectomy patients identifies CRP <4.2 mg/dL and neutrophil percentage <80.1% as preoperative predictors of simple versus complicated appendicitis. These biomarker cutoffs enable surgeons to tailor antibiotic selection—prophylactic cefazolin for simple cases versus therapeutic amoxicillin-clavulanate for complicated cases—optimizing antimicrobial stewardship.
- CRP <4.2 mg/dL predicts simple appendicitis; CRP >4.2 mg/dL suggests complicated appendicitis requiring broader antibiotic coverage.
- Neutrophil percentage >80.1% is associated with complicated appendicitis and may guide preoperative antibiotic selection.
- Preoperative CRP and neutrophil percentage can distinguish simple from complicated appendicitis with 84% and 70% accuracy respectively.
- Prophylactic cefazolin may suffice for simple cases (CRP <4.2), while amoxicillin-clavulanate therapy suits complicated cases (CRP >4.2).
- WBC count alone was not predictive; CRP and neutrophil percentage are superior preoperative markers for appendicitis severity.
Written by the GCMD Library team from the article.
Abstract
Introduction
The aim of this study was to find statistically valid criteria to preoperatively divide acute appendicitis into simple and complicated to enable surgeons to administer the most appropriate antibiotic prophylaxis/therapy before surgery.
Materials and methods
We retrospectively reviewed a cohort of patients who underwent appendectomy from January 2022 to December 2023. Patients included were 0–14 years of age. Exclusion criteria included patients who underwent interval appendectomy or concurrent procedures at the same time of appendectomy. We divided patients into two groups: simple (group S) and complicated (group C) appendicitis according to intraoperative finding. Generalized linear model (GLM) with logit function was developed to identify the predictive variables of the type of appendicitis (S vs C) in terms of CRP value, neutrophils percentage and WBC count adjusted for age and sex of patients. Finally, principal component analysis (PCA) was carried out to identify the cutoff value of statistically significant variables found in the previous analysis.
Results
One hundred and twenty patients were eligible (N female = 49, N male = 71) for the study. 74 and 46 patients were included in groups S and C, respectively. In a preliminary analysis using univariate and multivariate GLM, only CRP (p value = < 0.001) and neutrophils percentage (p value = 0.02) were predictive variables for the type of appendicitis. The GLM shows a statistical lower value of CRP (adjusted odds ratio [OR] per unit, 0.17 [95% CI, 0.08–0.39]) and neutrophil percentage (adjusted OR per unit, 0.37 [95% CI, 0.16–0.86]) in the S group compared to C adjusted to age and sex. PCA analysis revealed a P-ROC cutoff of 4.2 mg/dl and 80.1 of CRP value (AUC = 84%) and neutrophil percentage (AUC = 70%), respectively.
Conclusions
We will perform a prospective study giving preoperative prophylactic cefazolin to patients with a CRP value under 4.2 mg/dl and amoxicillin–clavulanate therapy to patient with CRP value over 4.2 mg/dl.