The Bacteriology and Septic Complication of Patients with Appendicitis

Lau, Wan Yee; Teoh-Chan, C. H.; Fan, Sheung Tat; Yam, Wing Cheong; Lau, Ka-Hin; Wong, Shawn

doi:10.1097/00000658-198411000-00003

Cited by 68 publications

(38 citation statements)

References 16 publications

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“…Its effectiveness against some aerobic and anaerobic bacteria has been also shown by hers. 23 Addition of topical antibiotics to systemic antibiotics was found beneficial in advanced appendicitis. [24][25] Bergamini et al 11 demonstrated in an experimental study that when wound contamination is great, a combination of topical and systemic antibiotics becomes more effective.…”

Section: Discussionmentioning

confidence: 99%

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Alshehri

Saif

Aliyu

et al. 1994

Annals of Saudi Medicine

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A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II (P<0.05). The reduction in infection rate was significant (P<0.05) in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis. Ann Saudi Med 1994;14(3):233-236. A considerable morbidity following appendectomy is caused by wound infection, 1-5 the rate of which ranges from 9% to 30% in early appendicitis and may reach up to 70% in advanced appendicitis.3-6 Systemic antibiotics were shown to reduce the wound infection rate significantly. 3,4,7 In vitro studies demonstrated 100% kill rates with clinically usable concentrations of antimicrobials in irrigating solutions after only 60-second exposure of the organisms. 8,9 Unlike parenterally administered antimicrobials, topical usage was found to attain prolonged effective local concentrations when used in the powder form. 10Experimental studies have shown that the combined use of systemic and topical antibiotics is better in advanced appendicitis than systemic antibiotics alone.11 Similarly, Seco et al. 12 have concluded in a clinical study that prophylaxis with a combination of systemic clindamycin and topical ampicillin solution, when compared with systemic clindamycin alone, was more effective in preventing wound infection after appendectomy, especially in patients with high wound contamination. However, the study of Seco et al. was criticized because the control group wounds were not irrigated with normal saline and clindamycin may not be the systemic antibiotic of choice for many surgeons. This communication aims at investigating the efficacy of the addition of topical ampicillin to systemic antimicrobials in reducing post appendectomy wound infection rate in a properly controlled randomized prospective study. Material and MethodsAll patients who underwent appendectomy through gridiron incision for clinically suspected acute appendicitis were considered for the study. Exclusion criteria were allergy to ampicillin and other systemic diseases requiring systemic antibiotic administration and therefore three patients who were allergic to ampicillin were excluded from the study, as well as another two patients who had valvular heart disease warranting preoperative prophylactic systemic ampicillin in addition to the systemic gentamicin and Flagyl. A total of 254 patients fulfilled the criteria of the study and were random...

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Section: Discussionmentioning

confidence: 99%

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Alshehri

Saif

Aliyu

et al. 1994

Annals of Saudi Medicine

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“…Elevation in serum CRP levels is seen with most invasive infections, grampositive and gram-negative bacterial systemic infections cause marked CRP rises, even in immunodefi cient patients [34], CRP has also been identifi ed as a marker of infection in patients with SIRS [35]. As a consequence, the increased levels shown by CRP in advanced perforated appendicitis are easily explained; patients with perforated appendicitis have a systemic infection caused by gram-negative bacteria, mainly Escherichia coli [22,23], these patients often have a SIRS, consequently their CRP levels rise progressively along with the time of evolution of appendicitis, from the onset to diagnosis and treatment.…”

Section: Laboratory Tests: Wbc and Crpmentioning

confidence: 99%

“…Recently, it has been proposed that an elevated total bilirubin (TB) level could be used as a specifi c marker for the prediction of perforated appendicitis [19,20]. The rationale for this proposal is based on the hepatic dysfunction occurring during bacterial sepsis secondary to Gram negative bacteria [21], such as Escherichia coli, which is the main bacteria present in patients with appendicitis [22,23]. Consequently a low-grade hyperbilirubinaemia, often unnoticed in septic patients not presenting clinically evident jaundice, is present in patients with gram-negative infections [24].…”

Section: Introductionmentioning

confidence: 99%

Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

Beltrán¹,

Méndez²,

Barrera³

et al. 2009

Indian J Surg

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Purpose To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms' evolution, and systemic infl ammatory response syndrome (SIRS).Methods Prospective observational study, applying receiver operating characteristics curve analysis to compare the sensitivity and specifi city of the tested variables. ResultsThe period of symptom's evolution was prolonged (105.2 ± 79.3 hours vs. 38.6 ± 17.5 hours), and CRP levels were higher in perforated appendicitis (176 ± 82.6 mg/l vs. 80 ± 76 mg/l). Most patients with perforated appendicitis had a SIRS score higher than 3 points. CRP (>76.7 mg/l), the time period of symptoms' evolution (>34.5 hours), and SIRS (3 points or more), were the best cutoff values to predict perforated appendicitis.Conclusions Perforated appendicitis may be suspected based on CRP, SIRS and the time period of symptoms' evolution. We do not recommend the use of total bilirubin to predict perforation in appendicitis.

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“…The risk of postappendectomy infections is related to the stage of appendicitis and varies from less than 10% following removal of a normal appendix to more than 50% in perforated appendicitis [1][2][3][4]. Systemic antibiot ics given pre-or intraoperatively effectively decrease the risk of wound infection and intraperitoneal sepsis [5][6][7][8][9][10], Controversy still exists, however, as to type of anti biotics, route of administration and duration of treat ment [1,11], Patients with gangrenous appendicitis are at high risk of developing postsurgical infection [12][13][14] and results from controlled studies support the benefit of antibiotic therapy in addition to surgery even in these patients [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Gangrenous Appendicitis

Søreide¹,

Krag²,

Klevgardb³

et al. 1987

Dig Surg

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Patients with gangrenous nonperforated appendicitis have a high risk of developing postsurgical infectious complications. The present prospective randomized multicenter study was performed to ascertain whether a single, intraoperative high dose (4 g) cefoxitin given intravenously effectively reduces infectious complications in these patients. The postsurgical infection rate in the treated group was 13.3% as compared to 41.9% in nontreated control patients. This reduction is statistically significant (p < 0.025). Cefoxitin given as a single dose of 4 g is a simple and safe treatment that effectively decreases postsurgical infectious complications in patients with nonperforated gangrenous appendicitis.

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The Bacteriology and Septic Complication of Patients with Appendicitis

Cited by 68 publications

References 16 publications

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

Gangrenous Appendicitis

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