Intraoperative cultures during appendectomy in children are poor predictors of pathogens and resistance patterns in cultures from postoperative abscesses

Abstract

Background Intraoperative cultures are commonly sent in complicated appendicitis. Culture-guided antibiotics used to prevent postoperative infectious complications are debated. In this study, we describe the microbial overlap between intraoperative and abscess cultures, and antibiotic resistance patterns. Method A local register of a children’s hospital treating children 0–15 years old with appendicitis between 2006 and 2013 was used to find cases with intraoperative cultures, and cultures from drained or aspirated postoperative intraabdominal abscesses. Culture results, administered antibiotics, their nominal coverage of the identified microorganisms, and rationales given for changes in antibiotic regimens were collected from electronic medical records. Results In 25 of 35 patients who met inclusion criteria, there was no overlap between the intraoperative and abscess cultures. In 33 of 35 patients, all identified intraoperative organisms were covered with postoperative antibiotics. In 14 patients, organisms in the abscess culture were not covered by administered antibiotics. Enterococci not found in the intraoperative culture were found in 12 of 35 abscesses. We found no difference in the antibiotic coverage between rationales given for antibiotic changes. Conclusion The overlap between intraoperative cultures and cultures from subsequent abscesses was small. Lack of antibiotic coverage of intraoperative cultures was not an important factor in abscess formation. Electronic supplementary material The online version of this article (10.1007/s00383-018-04428-3) contains supplementary material, which is available to authorized users.

Management and Microbiology of Perforated Appendicitis in Pediatric Patients: A 5-Year Retrospective Study

“…When bacterial growth was demonstrated, our findings were consistent with the literature, showing B. fragilis, E. coli , and Viridans group streptococcus as the most prevalent organisms [ 17 , 18 ]. The rate of P. aeruginosa growth has been documented between 17 and 28% among intraoperative cultures [ 4 , 17 , 18 ]. However, lower rates of P. aeruginosa were seen in our cohort: 15% of all intraoperative cultures and 12% of all postoperative abscess cultures.…”

“…Although the utility of intra-abdominal cultures in the setting of perforated appendicitis remains a subject for debate, our analysis shows that the yield of cultures diminishes as the collection moves further away from initial presentation, consistent with previous reports [ 17 ]. This is further illustrated by the seven cases where patients initially had bacterial growth on intraoperative culture only to later have a sterile culture at time of postoperative abscess formation.…”

“…When bacterial growth was demonstrated, our [17,18]. The rate of P. aeruginosa growth has been documented between 17 and 28% among intraoperative cultures [4,17,18]. However, lower rates of P. aeruginosa were seen in our cohort: 15% of all intraoperative cultures and 12% of all postoperative abscess cultures.…”

“…Although all cultures were pre-treated, since antibiotics are initiated prior to appendectomy or radiologic drainage, this trend is likely a product of ongoing antibiotic therapy. When bacterial growth was demonstrated, our [17,18]. The rate of P. aeruginosa growth has been documented between 17 and 28% among intraoperative cultures [4,17,18].…”

Sensibilidad antimicrobiana en aislamientos de líquido peritoneal de niños intervenidos por abdomen agudo e infección intraabdominal

“…Varios autores han reportado tasas de resistencia a la amoxicilina-clavulanato mayores de 40 % en los aislamientos de líquido peritoneal, factor que, sumado a la falta de cobertura para microorganismos como P. aeruginosa, tercer bacteria en frecuencia, hace necesario replantear la utilidad de los esquemas empíricos profilácticos y de los esquemas terapéuticos utilizados en la apendicitis aguda y rescata la importancia de hacer los cultivos de líquido peritoneal, los cuales han sido abandonados en favor de abordajes rutinarios en estas circunstancias 15,16 .…”