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. 2021 Dec;10(4):2247-2257.
doi: 10.1007/s40121-021-00502-x. Epub 2021 Jul 21.

Management and Microbiology of Perforated Appendicitis in Pediatric Patients: A 5-Year Retrospective Study

Alex S Plattner  1 , Jason G Newland  1 , Michael J Wallendorf  2 , Baddr A Shakhsheer  3
Affiliations

Management and Microbiology of Perforated Appendicitis in Pediatric Patients: A 5-Year Retrospective Study

Alex S Plattner et al. Infect Dis Ther. 2021 Dec.

Abstract

Introduction: This study aims to assess the current epidemiology and microbiology of perforated appendicitis, how antibiotic choice and duration correlate with meaningful clinical outcomes, and whether serial white blood cell (WBC) counts provide clinical value.

Methods: Five-year retrospective cohort study, 2015-2019, among 333 consecutive children, ages 0-18 years, treated at St. Louis Children's Hospital for perforated appendicitis. Main outcomes included length of stay (LOS), postoperative abscess formation, and readmission. Statistical analysis was performed with uni- and multi-variate analyses.

Results: Intra-abdominal cultures most commonly grew Bacteroides fragilis (52%) and Escherichia coli (50%). Patients who initially received broad-spectrum antibiotics (meropenem, piperacillin-tazobactam, fourth-generation cephalosporins) for perforated appendicitis had greater rates of postoperative abscess formation (25% vs. 12%, p < 0.01) and LOS (7.0 vs. 5.7 days, p < 0.01). Similarly, antibiotics at time of discharge were associated with greater postoperative abscess formation (22% vs. 9%, p < 0.01) and LOS (6.4 vs. 5.6 days, p = 0.02). However, discharge with strictly oral antibiotics was not correlated with greater LOS, postoperative abscess formation, or readmission rates compared to discharge without antibiotics. Serial WBC counts had no predictive value for LOS, postoperative abscess formation, or readmission.

Conclusions: Bacteroides fragilis and E. coli were the most common intra-abdominal microbes for perforated appendicitis among our cohort. In non-critically ill children, the routine use of broad-spectrum antibiotics or continuation of antibiotics beyond discharge was not correlated with improved clinical outcomes. Additionally, WBC counts were not correlated with meaningful clinical outcomes.

Keywords: Antibiotic stewardship; Complicated appendicitis; Pediatric surgery.

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Figures

Fig. 1
Fig. 1
Perforated appendicitis rates by age. The bar graph shows the study population segmented by age. The line graph represents perforation rate, by age, of all patients with appendicitis seen at St. Louis Children’s Hospital from 2015–2019
See this image and copyright information in PMC

References

    1. Stpeter SD. Appendicitis. In: Holcomb GW, Murphy JP, editors. Ashcraft’s pediatric surgery. 5. Philadelphia: Saunders Elsevier; 2010. p. 549.
    1. Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev. 2005;(3). - PMC - PubMed
    1. Akingboye AA, Davies B, Tien T. Pus samples in complicated appendicitis: an important investigation or a waste of resources: a prospective cohort study. Scand J Surg. 2019;108(1):55–60. doi: 10.1177/1457496918783721. - DOI - PubMed
    1. Turel O, Mirapoglu SL, Yuksel M, Ceylan A, Gultepe BS. Perforated appendicitis in children: antimicrobial susceptibility and antimicrobial stewardship. J Glob Antimicrob Resist. 2019;1(16):159–161. doi: 10.1016/j.jgar.2018.09.015. - DOI - PubMed
    1. Roque FM, Melo Filho AA, Roque AJ, Roque HC, Moreira TM, Chaves EM. Antibiotics for appendicectomy in children and adolescents during the perioperative period: an integrative review. Revista Paulista de Pediatria. 2019;37(4):494–502. doi: 10.1590/1984-0462/;2019;37;4;00013. - DOI - PMC - PubMed

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