Susceptibility to antibiotics of aerobic bacteria isolated from community acquired secondary peritonitis in children: therapeutic guidelines might not always fit with and everyday experience

Abstract

Appendicitis is a frequent clinical condition in normal children that may be complicated by community-acquired secondary peritonitis (CASP). We evaluated the potential efficacy of different drugs for initial treatment of this condition, as recommended by recent Consensus Conference and Guidelines for paediatric patients. Susceptibility to ampicillin-sulbactam, ertapenem, gentamycin, piperacillin, piperacillin-tazobactam, vancomycin, and teicoplanin was evaluated according to EUCST 2012 recommendations in aerobic bacteria isolated from peritoneal fluid in CASP diagnosed from 2005 to 2011 at 'Istituto Giannina Gaslini', Genoa, Italy. A total of 114 strains were analysed: 83 E. coli, 15 P. aeruginosa, 6 Enterococci, and 10 other Gram-negatives. Resistance to ampicillin-sulbactam was detected in 37% of strains, while ertapenem showed a potential resistance of 13% (all P. aeruginosa strains). However, the combination of these drugs with gentamicin would have been increased the efficacy of the treatment to 99 and 100%, respectively. Resistance to piperacillin-tazobactam was 3%, while no strain was resistant to meropenem. Our data suggest that monotherapy with ampicillin-sulbactam or ertapenem for community-acquired secondary peritonitis would present a non-negligible rate of failure, but the addition of gentamycin to these drugs could reset to zero this risk. On the contrary, monotherapy with piperacillin-tazobactam or meropenem is highly effective.

European Paediatric Surgeons' Association Survey on the Management of Pediatric Appendicitis

“…30 The most recent evidence-based recommendations of the American Pediatric Surgical Association Outcomes and Clinical Trials Committee support the preoperative use of broad spectrum antibiotics in children with non-perforated appendicitis. 31 Given the peculiar local epidemiology of most bacterial and fungal cultures, some centers resort to hospital-based guidelines on antibiotic treatment for acute appendicitis, 32 and this may explain the heterogeneity between antibiotic regimes among respondents.…”

The importance of culture-antibiogram and evaluation of the empirical antibiotic treatment in peritonitis due to perforated appendicitis acquired intra-abdominal infection

“…Castagnola et al evaluated community acquired peritonitis following appendicitis in cultures of peritoneal fluid on children [9]. A total of 114 strains were examined including 83 strains of E. coli, 15 strains of P. aeruginosa, 6 strains of enterococcus and 10 strains of other gram negative bacteria, and the ratio of ampicillin/sulbactam and ertapenem resistance were determined as 37% and 13%, and all of the P. aeruginosa strains were found to be resistance to both antimicrobial agents.…”

Severe autogenously fecal peritonitis in ageing Wistar rats. Response to intravenous meropenem

“…Meropenem tends to provide better antibiotic coverage for spontaneous bacterial peritonitis in severe patients with cirrhosis when compared with third generation cephalosporin 13 , and for other sepsis due to secondary peritonitis 14 .…”