Streptococcus milleri in intraabdominal abscesses in children after appendectomy: incidence and course

Leeuwenburgh, Marjolein M. N.; Monpellier, Valerie M.; Vlaminckx, Bart J. M.; Go, P. M. N. Y. H.

doi:10.1016/j.jpedsurg.2011.08.004

Cited by 11 publications

(10 citation statements)

References 24 publications

(23 reference statements)

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“…Two patterns that we noted regarding the most common organisms in IAAs were that S. anginosus tended to be present also in intraoperative culture (5/6), whereas Enterococci were found de novo in the abscesses. When S. anginosus is present in the intraoperative swab, previous studies indicate that abscess formation is overrepresented [8, 12, 13], and that S. anginosus is overrepresented in complicated appendicitis [14]. We believe that organisms found in the IAA are present at the time of initial surgery, unless some unknown mechanism of contamination other than the perforation event itself occurs in a large proportion of the patients.…”

Section: Discussionmentioning

confidence: 79%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 79%

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

et al. 2019

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“…The association of S. angiosus group with abscess is incompletely understood but may be attributed to the production of hydrolytic enzymes and hydrogen peroxide by these bacteria which can interfere with neutrophil function and possibly promote neutrophil death ( 30 , 31 ). Isolation of S. anginosus group has been previously associated with the risk of developing a post-operative phlegmon or abscesses and prolonged hospital stay in other studies ( 32 , 33 ). An unanticipated observation in the microbiological studies was the isolation of Pseudomonas aeruginosa in peritoneal cultures in 24% of the patients, although this was not associated with increased LOS.…”

Section: Discussionmentioning

confidence: 79%

Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis

et al. 2022

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ObjectiveIn children with appendicitis, rupture of the appendix is associated with a significant increase in morbidity. We sought to characterize the spectrum of illness in children with complicated appendicitis and to define those factors associated with a longer hospital stay.Study DesignWe conducted a retrospective review of 132 children, 18 years of age or younger at a large urban teaching hospital in the Bronx, NY between October 2015 and April 2018 with an intraoperative diagnosis of perforated appendix. Clinical, laboratory and radiologic findings were reviewed, and the primary study outcome was length of stay (LOS) dichotomized at the median, which was 7 days. Statistical analyses were done to characterize morbidity and define variables predictive of longer stay.ResultsChildren in the longer LOS group experienced significantly more morbidity, including ICU stay, ileus, and need for multiple drainage procedures. A longer duration of symptoms prior to presentation was associated with a longer stay. Multivariable logistic regression analysis indicated that the presence of abscess and presence of free fluid in the right upper quadrant (RUQ FF) on initial imaging and C-reactive protein (CRP) level >12 at admission, were independently associated with a longer stay.ConclusionThere is considerable variation in the morbidity of complicated appendicitis. The association between longer stay and the findings of abscess and RUQ FF on initial imaging along with an elevated CRP may provide a useful tool in identifying those children at risk for worse outcomes.

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“…10 Broad-spectrum antibiotics, such as ampicillin, gentamicin and metronidazole combination therapy, are recommended as initial empiric treatment. 9 The intravenous antibiotic choices in our study were varied and included extended-spectrum penicillins and third-generation cephalosporins. The choice of amoxicillin-clavulanate as the 'stepdown' oral antibiotic most likely reflects the polymicrobial nature of these infections.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of SAG infections usually requires drainage of abscesses and antibiotic therapy, which may be prolonged if involving intracranial sites, necrotising pneumonia, multiple small undrainable abscesses within the abdomen or complicated skeletal infections. 9,10,[20][21][22] Other than the aforementioned infections, once abscesses are drained and primary source control achieved, 1-2 weeks of antibiotics is generally sufficient if accompanied by a good clinical response. 10 Since SAG infections are often polymicrobial in nature, broad-spectrum antibiotics are commenced according to the most likely responsible pathogens, and the nature and site of the infection.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus anginosus group infections in hospitalised children and young people

Ismail

Hughes

Moloney

et al. 2021

J Paediatrics Child Health

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Aim The Streptococcus anginosus group (SAG) comprises three bacterial species colonising the mouth and gastrointestinal and genitourinary tracts and capable of serious pyogenic infections. Although well‐described in adults, studies in children are limited. Here, we characterise paediatric SAG infections from a single Australian centre. Methods Hospitalised patients aged ≤18 years with positive SAG cultures from January 2009 to December 2019 were identified from Pathology Queensland's Gold Coast Laboratory database and their medical records were reviewed. Results Two‐hundred children (62% male), median age 12 years (interquartile range 6–16), with positive SAG cultures were identified. Overall, 90% received intravenous antibiotics, 89% underwent surgical drainage, 23% were readmitted and 15% required additional surgery. The most common sites were the abdomen (39%), soft tissues (36%) and head and neck regions (21%). Since 2011, Pathology Queensland reported SAG at the species level (n = 133). Of these, S. anginosus was the most prevalent (39%), then S. constellatus (34%) and S. intermedius (27%). Compared with the other two species, S. intermedius was most commonly associated with head and neck infections (relative risk (RR) = 2.2, 95% confidence interval (CI) 1.4–3.5), while S. constellatus (RR = 1.7, 95% CI 1.2–2.4) and S. anginosus (RR = 1.5, 95% CI 1.0–2.0) were each associated with a higher risk of intra‐abdominal infection than S. intermedius. Since February 2015, the number of children admitted with SAG‐associated intra‐abdominal infection per 1000 hospitalisations increased by 29% annually compared with an annual decline of 8% in previous years. Conclusions SAG infections occur at various anatomical sites. Despite antibiotics and surgical management, almost one‐quarter are re‐hospitalised for further treatment.

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Streptococcus milleri in intraabdominal abscesses in children after appendectomy: incidence and course

Cited by 11 publications

References 24 publications

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

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

Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis

Streptococcus anginosus group infections in hospitalised children and young people

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