Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2025; 17(4): 104712
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.104712
Comparison of the efficacy of carbapenems and cephalosporins for postoperative treatment of perforated appendicitis in children
Tian Hang, Qiao-Lin Chen, Ya-Hong Li, Shi-Wen Wang, Xiao-Hong Jiang, Wei-Chao Zhu
Tian Hang, Department of Pediatric Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing 314009, Zhejiang Province, China
Qiao-Lin Chen, Wei-Chao Zhu, Department of Pediatric Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315010, Zhejiang Province, China
Ya-Hong Li, Shi-Wen Wang, Department of Pediatric Surgery, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Xiao-Hong Jiang, Department of Pathology, Jiaxing Women and Children Hospital affiliated to Jiaxing University, Jiaxing 314009, Zhejiang Province, China
Co-first authors: Tian Hang and Qiao-Lin Chen.
Co-corresponding authors: Xiao-Hong Jiang and Wei-Chao Zhu.
Author contributions: Hang T, Jiang XH and Zhu WC designed the research study; Jiang XH and Zhu WC review the research process and manuscript; Hang T, Chen QL, Li YH and Wang SW performed the research; Hang T, Chen QL writing-original draft preparation; Hang T and Chen QL writing-review and editing; Hang T and Chen QL data curation; Hang T, Chen QL, Li YH and Wang SW formal analysis. All authors have read and approve the final manuscript. Hang T and Chen QL contributed equally to this work as co-first authors. Both Jiang XH and Zhu WC have contributed equally to the roles expected of a corresponding author, as defined by your journal's guidelines. Specifically: (1) Academic leadership: Author Jiang XH led the fieldwork/data analysis/theoretical framework and oversaw the integration of interdisciplinary methodologies. Author Zhu WC directed the research design/clinical validation/technical development and coordinated collaborations with external partners; (2) Responsibility for communication: Author Jiang XH will handle inquiries related to methodology and data curation. Author Zhu WC will manage questions regarding clinical implications and technical details; and (3) Institutional requirements: This work was jointly supported by Jiaxing Maternity and Child Health Care Hospital and The First Affiliated Hospital of Ningbo University, and both institutions recognize the dual corresponding authorship to reflect the collaborative nature of the project.
Supported by Jiaxing Science and Technology Plan Project, No. 2024AD30035.
Institutional review board statement: This study was approved by the Institutional Review Board of Jiaxing Women and Children Hospital affiliated to Jiaxing University of Science and Technology (No. KY-2022-224).
Informed consent statement: In this retrospective study design, the requirement for informed consent from the study subjects was approved by the ethics committee of Jiaxing Women and Children Hospital affiliated to Jiaxing University. All subjects provided informed consent from their parents and/or legal guardians. Only patients’ file number were extracted with the data and no names or identifiable information was included. In addition, the committee ensured that all methods used in this research were performed in accordance with relevant guidelines/regulations.
Conflict-of-interest statement: The authors declare that there are no competing interests.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Chao Zhu, MD, Department of Pediatric Surgery, The First Affiliated Hospital of Ningbo University, No. 247 Renmin Road, Jiangbei District, Ningbo 315010, Zhejiang Province, China. fyzhuweichao@nbu.edu.cn
Received: January 8, 2025
Revised: February 7, 2025
Accepted: February 21, 2025
Published online: April 27, 2025
Processing time: 79 Days and 23.2 Hours
Abstract
BACKGROUND

Pediatric perforated appendicitis (PPA) is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy. Antibiotic selection differs significantly among pediatric centers, and an ideal postoperative anti-infective approach for PPA management has yet to be established.

AIM

To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem (CBP) and cephalosporin (CPS) antibiotics.

METHODS

We retrospectively analyzed medical records of 65 children (43 boys, 22 girls; mean age 6.92 ± 3.41 years) with PPA who underwent surgery at our hospital between December 2019 and August 2022. Data were collected in September 2023. Based on postoperative antibiotic selection, patients were divided into CBP (32 cases) and CPS (33 cases) groups. Chi-square and T-tests compared recovery outcomes, while univariate and multivariate regression models identified independent factors affecting postoperative recovery.

RESULTS

There were no significant differences between the two groups in gender, age, weight, height, body mass index, baseline ear temperature, or heart rate (P > 0.05). Escherichia coli (40.00%) and Pseudomonas aeruginosa (24.62%) were the most common pathogens in PPA. Postoperative analysis showed significantly shorter C-reactive protein (CRP) recovery times in the CPS group than in the CBP group [(6.18 ± 1.84) vs (8.12 ± 3.48) days, P = 0.009]. Univariate logistic regression indicated CPS selection (OR = 0.32, 95%CI: 0.10-0.97, P = 0.044) was significantly associated with a higher CRP recovery rate within 7 days. Multivariate analysis confirmed CPS selection (OR = 3.49, 95%CI: 1.19-10.24, P = 0.023) as an independent factor affecting CRP recovery within 7 days postoperatively.

CONCLUSION

The choice of CBP or CPS independently affects CRP recovery within 7 days. CBP offers no advantage over CPS in treating PPA, with CPS also demonstrating favorable clinical outcomes.

Keywords: Children; Perforated appendicitis; Pathogenic bacteria; Carbapenems; Cephalosporins

Core Tip: In the management of pediatric perforated appendicitis (PPA) post-surgery, our retrospective study demonstrates that cephalosporins (CPS) are as effective as carbapenems in achieving favorable clinical outcomes. Notably, CPS use is associated with significantly faster C-reactive protein recovery within seven days, highlighting its potential as a preferred antibiotic choice. These findings support optimizing antibiotic selection to enhance postoperative recovery and mitigate the risks of antibiotic resistance in children treated for PPA.