Perforated appendicitis in children: Antimicrobial susceptibility and antimicrobial stewardship.

Perforated appendicitis in children: Antimicrobial susceptibility and antimicrobial stewardship.

J Glob Antimicrob Resist. 2018 Sep 27;:

Authors: Turel O, Mirapoglu SL, Yuksel M, Ceylan A, Gultepe BS

Abstract
BACKGROUND: For perforated appendicitis in children microbiological cultures should always be sought if adequate sample is available. Knowledge of local epidemiology is important for optimal selection of antimicrobial agents.
OBJECTIVE: We aimed to evaluate etiology and susceptibility of pathogens in patients with perforated appendicitis.
METHODS: Microbiological results of tissue samples obtained at surgery from children with acute appendicitis during 24 months were evaluated retrospectively.
RESULTS: Among 209 children operated for acute appendicitis 62 (29.6%) were perforated appendicitis. Intraperitoneal culture results were available for 42 patients and 95.2% had positive microbiological growth (55 pathogens). Male to female ratio was 1.8 and mean age was 11 years (range 4 to 18 years). The most common pathogen was Escherichia coli (67.2%) and 56.7% were producing extended spectrum b-lactamase (ESBL). All patients received an initial treatment with intravenous antibiotics (ampicillin, gentamicin, and metronidazole). The antibiotic regimen was modified in 23 patients (53.5%). Seven (16.2%) patients developed a postoperative complication. No significant difference was observed for development of complications between patients with ESBL positive and negative E. coli growth (p=0.698).
CONCLUSION: High rate of ESBL-positive E. coli may indicate bowel colonization with resistant bacteria even in the community setting. Prospective studies will show whether treatment options shall be directed according to identified pathogens.

PMID: 30268808 [PubMed - as supplied by publisher]