An antimicrobial stewardship intervention to reduce the use of piperacillin–tazobactam in children with acute appendicitis has been shown to result in improved clinical outcomes.
In a single-centre retrospective observational study conducted in Colombia, the intervention was associated with more than 90-percent reduced odds of piperacillin–tazobactam use (odds ratio, 0.076, 95 percent confidence interval, 0.04–0.14; p<0.01), without increased risk of postoperative complications or readmissions after discharge. [ESPID 2026, abstract OP-054 / #152]
The Antimicrobial Stewardship Program intervention assessed in the study was structured into three parts: (1) updating the institutional protocol to recommend ampicillin–sulbactam plus amikacin for uncomplicated appendicitis and peritonitis; (2) educational activities for healthcare staff; and (3) audit and feedback.
“Before the intervention, excessive piperacillin–tazobactam use was favoured due to the lack of antibiotic regulation,” reported first study author Dr Andrea Orozco Pinzón from Pablo Tobón Uribe Hospital, Medellín, Colombia.
The WHO classifies piperacillin–tazobactam as a “watch” antibiotic reserved for hospital-acquired infections. Excessive use of this antibiotic may lead to antimicrobial resistance, Clostridioides difficile infection, nephrotoxicity, and increased healthcare costs, according to Orozco Pinzón.
“The implementation of the stewardship program contributed substantially to reducing the piperacillin–tazobactam consumption, highlighting the importance of in-hospital education and standardized prescribing practices,” she said.
In the study, Orozco Pinzón and colleagues looked at 305 paediatric patients (median age 8 years, 66 percent male) with complicated appendicitis treated at their hospital. Of these, 151 were included in the preintervention group (2018–2021) and 154 in the postintervention group (2022–2024).
Baseline characteristics such as sex, age, area of origin, and presence of comorbidities were similar between the two patient groups. Escherichia coli was the most common pathogen, isolated in 46 percent of patients in the preintervention group and in 48 percent in the postintervention group. There were no differences in overall microbial distribution.
Compared with the preintervention group, the postintervention group had markedly reduced exposure to piperacillin–tazobactam (16.2 percent vs 96 percent; p<0.001), shorter duration of antibiotic therapy (median, 5 vs 7 days; p<0.001), and shorter hospital length of stay (median 5 vs 7 days; p<0.001).
There were no significant between-group differences noted in postoperative complications (35.3 percent vs 43.8 percent; p=0.237), emergency department readmission (8.4 percent vs 19.8 percent; p=0.13), and hospital readmission (92.3 percent vs 53.3 percent; p=0.59). However, all outcomes occurred with less frequency in the postintervention group.
Overall, these findings demonstrate that the Antimicrobial Stewardship Program can promote rational antibiotic use, avoiding unnecessary exposure to broad-spectrum antibiotics and reducing its negative impact on nosocomial pathogens, Orozco Pinzón said.
“The development of institutional guidelines and continuous education are key to achieving Antimicrobial Stewardship Program goals. This strategy may be replicated in other institutions,” she added.