dgkh000680
10.3205/dgkh000680
urn:nbn:de:0183-dgkh0006802
Letter to the Editor
Optimization of antibiotic use after appendectomy for uncomplicated appendicitis in adults: further evidence supporting restriction of postoperative antibiotic therapy
Optimierung des Antibiotikaeinsatzes nach Appendektomie bei unkomplizierter Blinddarmentzündung bei Erwachsenen: weitere Belege für eine Einschränkung der postoperativen Antibiotikatherapie
Mellado-García
Mellado-García
María
M
MD
San Bartolomé, 6, CP: 30130, Beniel, Murcia, Spain; phone: +34 680819812General Surgery Resident. Hospital General Universitario Reina Sofía, Murcia, Spain
melladogarcia00@gmail.com
author
Dahmouni-Dahmouni
Dahmouni-Dahmouni
Hajar
H
General Surgery Resident. Hospital General Universitario Reina Sofía, Murcia, Spain
author
Sandoval-Marín
Sandoval-Marín
Jesús
J
General Surgery Resident. Hospital General Universitario Reina Sofía, Murcia, Spain
author
González-Valverde
González-Valverde
Miguel
M
General and Digestive Surgery Service. Hospital General Universitario Reina Sofía, Murcia, Spain
author
German Medical Science GMS Publishing House
Düsseldorf
610
20261007
engl
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung).
2196-5226
21
GMS Hygiene and Infection Control
GMS Hyg Infect Control
71
Letter to the editorDear editor,We read with great interest the recent article by Beltz et al. , in which the authors described the positive impact of implementing a standardized protocol based on antimicrobial stewardship principles on postoperative antibiotic management in pediatric appendicitis. They demonstrated significant improvements in the quality of antibiotic therapy, including reduced postoperative antibiotic exposure without an increase in complications.We would like to provide additional evidence supporting this strategy in the setting of emergency surgery in adult patients.At our secondary-level hospital, we conducted a retrospective pre–post quality improvement study to evaluate the effect of a low-cost educational intervention on postoperative antibiotic prescribing after appendectomy for uncomplicated acute appendicitis. The intervention, carried out between October and December 2025 as part of our Antimicrobial Stewardship Program (ASP), consiste<![CDATA[d of e</PlainText></TextGroup>ducational sessions for the surgical team, dissemination of updated recommendations, and reminder posters placed in surgical and inpatient areas.</Pgraph><Pgraph>During the pre-intervention period (January–September 2025), 25 of 139 patients with uncomplicated appendicitis (17.9%) received postoperative antibiotic therapy despite adequate surgical source control. Following the intervention, only 4 of 39 patients (10.3%) receive<TextGroup><PlainText>d p</PlainText></TextGroup>ostoperative antibiotics during the post-intervention period (January–March 2026), representing a relative reduction of 42.9%, without an increase in postoperative complications.</Pgraph><Pgraph>Our results were similar to those reported by Beltz et al. <TextLink reference="1"></TextLink>, despite involving an adult population and a different hospital setting. In both studies, a substantial proportion of postoperative antibiotic exposure after appendectomy appeared to remain avoidable and was mainly related to persistent clinical variability and routine antibiotic use rather than evidence-based indications.</Pgraph><Pgraph>Current guidelines do not recommend postoperative antibiotic therapy for uncomplicated appendicitis after adequate appendectomy and proper source control <TextLink reference="2"></TextLink>, <TextLink reference="3"></TextLink>, <TextLink reference="4"></TextLink>. Nevertheless, this practice remains common in daily clinical care. Such unnecessary exposure is not harmless and contributes to bacterial resistance, adverse drug reactions, <Mark2>Clostridioides difficile</Mark2> infection, prolonged hospital stay, and increased healthcare costs. Recent recommendations from the Surgical Infection Society and the WSES guidelines have emphasized the importance of introducing antimicrobial stewardship strategies in emergency surgery <TextLink reference="3"></TextLink>, <TextLink reference="4"></TextLink>.</Pgraph><Pgraph>In our experience, relatively simple educational interventions achieved clinically relevant improvements without requiring complex structural changes or additional economic resources. Therefore, the implementatio<TextGroup><PlainText>n of s</PlainText></TextGroup>tandardized protocols and continued educational reinforcement may help improve adherence to evidence-based recommendations.</Pgraph><Pgraph>Recent large-scale analyses of pediatric appendicitis care have shown a progressive reduction in unnecessar<TextGroup><PlainText>y p</PlainText></TextGroup>ostoperative antibiotic use over recent years <TextLink reference="5"></TextLink>. This likely reflects greater incorporation of antimicrobial stewardship programs into surgical practice. However, considerable variability between centers still persists, suggesting substantial room for improvement.</Pgraph><Pgraph>We agree with Beltz et al. <TextLink reference="1"></TextLink> that antimicrobial stewardship principles should be systematically integrated into appendicitis management pathways. Prospective multicenter studies, in both pediatric and adult populations, would be valuable to confirm these findings and support broader implementation of these strategies in routine clinical practice.</Pgraph></TextBlock>
<TextBlock name="Notes" linked="yes">
<MainHeadline>Notes</MainHeadline><SubHeadline>Authors’ ORCIDs </SubHeadline><Pgraph><UnorderedList><ListItem level="1">Mellado-García M: <Hyperlink href="https://orcid.org/0000-0003-4308-3574">https://orcid.org/0000-0003-4308-3574</Hyperlink></ListItem><ListItem level="1">Dahmouni-Dahmouni H: <Hyperlink href="https://orcid.org/0009-0006-2088-4511">https://orcid.org/0009-0006-2088-4511</Hyperlink></ListItem><ListItem level="1">Sandoval-Marín J: <Hyperlink href="https://orcid.org/0009-0004-8705-3910">https://orcid.org/0009-0004-8705-3910</Hyperlink></ListItem><ListItem level="1">González-Valverde FM: <Hyperlink href="https://orcid.org/0000-0002-7668-3667">https://orcid.org/0000-0002-7668-3667</Hyperlink></ListItem></UnorderedList></Pgraph><SubHeadline>Funding</SubHeadline><Pgraph>This research has not received funding from public sector agencies, commercial entities, or non-profit organisations</Pgraph><SubHeadline>Competing interests</SubHeadline><Pgraph>The authors declare that they have no competing interests.</Pgraph><SubHeadline>AI usage statement</SubHeadline><Pgraph>Artificial intelligence was used exclusively for linguistic enhancement. All scientific content and writing are the sole work of the author.</Pgraph></TextBlock>
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