The microbiology of bacterial peritonitis due to appendicitis in children

Abstract

AimThe aim of this study was to investigate the microbiology of secondary bacterial peritonitis due to appendicitis and the appropriateness of current antimicrobial practice in one institution.MethodsA 14-year retrospective single-centre study of 69 consecutive paediatric patients (age 1–14 years) with appendicitis-related peritonitis and positive peritoneal specimen cultures was conducted. Post-operative outcomes, microbiology and antibiotic susceptibility of peritoneal isolates were analysed in all patients.ResultsEscherichia coli was identified in 56/69 (81 %) peritoneal specimens; four isolates were resistant to amoxicillin–clavulanate, and one other isolate was resistant to gentamicin. Anaerobes were identified in 37/69 (54 %) peritoneal specimens; two anaerobic isolates were resistant to amoxicillin–clavulanate and one isolate was resistant to metronidazole. Pseudomonas aeruginosa was identified in 4/69 (6 %) peritoneal specimens, and all were susceptible to gentamicin. Streptococcal species (two Group F streptococci and three β-haemolytic streptococci) were identified in 5/69 (7 %) specimens, and all were susceptible to amoxicillin–clavulanate. Combination therapy involving amoxicillin–clavulanate and aminoglycoside is appropriate empirical treatment in 68/69 (99 %) patients. Addition of metronidazole to this regime would provide 100 % initial empirical coverage. Inadequate initial empiric antibiotic treatment and the presence of amoxicillin–clavulanate resistant E. coli were independent predictors of the post-operative infectious complications observed in 14/69 (20 %) patients.ConclusionE. coli and mixed anaerobes are the predominant organisms identified in secondary peritonitis from appendicitis in children. Inadequate initial empirical antibiotic and amoxicillin–clavulanate resistant E. coli may contribute to increased post-operative infectious complications. This study provides evidence-based information on choice of combination therapy for paediatric appendicitis-related bacterial peritonitis.

Peritonitis in Children: Experience in a Tertiary Hospital in Enugu, Nigeria

“…The reason for this gender difference is not known. The median age of our patients of nine years is also similar to the reports of other studies [12,13] . The published median ages of patients with peritonitis vary from five to 11.8 years [10,14,15] .…”

Does microbial resistance profile change in community-based intra-abdominal infections? Evaluation of the culture results of patients with appendicitis

“…The rate of community-based ESBL positive E. coli among cases with intra-abdominal infectionrelated appendicitis was 46%. In a study investigating the microbial culture results of pediatric patients with appendicitis in Ireland, E. coli was found to be the infectious agent at a rate of 81% and no ESBL positivity was detected 17 . However, data of the study belonged to years 1995-2008.…”

Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis

“…Since our success rate for nonoperative treatment with first line antibiotics (cefmetazole) was 85.7%, changing the antibiotics was helpful for 13.0 % of patients. The most common organism causing appendicitis is Escherichia coli, followed by Bacteroides species, and then Enterococcus, Streptococcus, Pseudomonas, and Klebsiella species [13,14]. Therefore, we chose the secondgeneration cephem, cefmetazole, which has a wide-spectrum covering both aerobic and anaerobic bacteria, as our first-line antibiotic.…”