AB020. SOH25_AB_040. “We won’t insist as the microbes resist”—laparoscopic appendectomy intra-peritoneal culture 2 years audit: quality improvement project

Background: The current protocol of perioperative management of appendicitis in Children’s Hospital Ireland (CHI) depends mainly on Co-amoxiclav. It was noticed that the number of patients with Co-amoxiclav resistance increased and this may lead to longer hospital stay and increase risk of post-operative complication. Therefore, we conducted a clinical audit from which to update the current protocol using the most recent data.

Methods: A review was conducted of intra-abdominal swab culture for all patients who underwent laparoscopic appendectomy in Temple Street in 2022–2023. Excel was used for data collection and analysis.

Results: Approximately 43% (56/130) of patients had peritoneal swab culture in 2022 versus 31% (48/155) in 2023. Growth of bacteria was noticed in 77% of those who had intra-peritoneal swab culture in 2022 versus 73% in 2023. The heaviest growth (primary bacteria) from intra-peritoneal culture was E. coli which accounted for two thirds in both years. There was no Pseudomonas growth in primary bacteria in 2022, but Pseudomonas did account for 10% in 2023. Bacteroides was found in 33% of secondary bacterial growth in 2022 and 2023. Streptococcus remained the most prominent secondary bacteria in both years. For antibiotic resistance, 61% of E. coli was resistant to augmentin in 2022 versus 55% in 2023. 10–12% demonstrated resistance to cephalosporin in both years. No evidence of resistant to ceftriaxone was recorded.

Conclusions: Based on the above, cephalosporin and metronidazole (bacteroides coverage) are recommended main antibiotics for perioperative appendicitis management instead of Co-amoxiclav.

Keywords: Appendicitis; antibiotics; bacteria; culture; paediatric