The Use of Routine Blood Cultures in Pediatric Appendicitis

Abstract

True-positive blood cultures are very rare in children presenting to the ED with suspected appendicitis. Given the potential for false-positive cultures and the social/economic implications of initial testing/retesting of false positives, the use of routine blood cultures for children with suspected appendicitis is not supported.

Blood culture positivity in patients with acute appendicitis: A propensity score–matched prospective cohort study

“…One retrospective study on children reported bacteremia of 17% and 8% in perforated and non-perforated acute appendicitis, 24 when in our study bacteremia was diagnosed in 15% and 5%, respectively. There was huge variety in the overall prevalence in the earlier studies ranging from 0.35% to 17%, 22–24 and as all these other studies were performed in pediatric populations, they are not directly comparable to our study with adult patients. Both epidemiological and clinical studies have shown that non-operative treatment for uncomplicated acute appendicitis is efficient, safe, and cost-effective.…”

“…To our knowledge, there is only one previous study assessing blood culture positivity in adult patients with acute appendicitis. 17 The bacteremia prevalence rate in this study 17 and the earlier studies mainly in pediatric patient cohorts 22–24 are corroborated by the outcomes of this study. One retrospective study on children reported bacteremia of 17% and 8% in perforated and non-perforated acute appendicitis, 24 when in our study bacteremia was diagnosed in 15% and 5%, respectively.…”

“…23 In a retrospective cohort of 1315 children, there were 288 patients with available blood culture data on admission with a blood culture positivity prevalence of 0.35%. 22 A recent metagenome analysis study profiling bacterium in ascites and blood of patients with acute surgical abdomen found no positive blood cultures in patients with appendicitis. 25…”

“…17 There are studies assessing bacteremia postoperatively after appendectomy 18 and many studies with specimens obtained from appendiceal lumen or swab samples from suppurative peritoneal fluid or periappendiceal abscess, [19][20][21] but only few small studies on bacteremia in pediatric patients with appendicitis on admission. 22,23 In the early 1990s, a small retrospective study on children reported positive blood cultures of 17% and 8% in perforated and nonperforated acute appendicitis, respectively. 24 In a small prospective pediatric study, the prevalence of bacteremia in patients with acute appendicitis was 6%.…”

“…23 In a retrospective cohort of 1315 children, there were 288 patients with available blood culture data on admission with a blood culture positivity prevalence of 0.35%. 22 A recent metagenome analysis study profiling bacterium in ascites and blood of patients with acute surgical abdomen found no positive blood cultures in patients with appendicitis. 25 Bridging the knowledge gaps in understanding the etiology and pathophysiology of uncomplicated and complicated acute appendicitis is of utmost importance to be able to optimize the accuracy of the pre-intervention diagnosis of appendicitis severity allowing the assessment and tailoring of all available treatment options accordingly.…”