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. 2025 Mar 21;44(9):826-831.
doi: 10.1097/INF.0000000000004800.

Microbiologic and Clinical Characteristics of Pediatric Appendicitis: A Retrospective Cohort Study on Antibiotic Resistance and Treatment Options

Eliyahu Adhehani  1 , Zaki Assi  1   2 , Moshe Shmueli  1 , Roman Streltsov  1   2 , Shalom Ben-Shimol  1   3
Affiliations

Microbiologic and Clinical Characteristics of Pediatric Appendicitis: A Retrospective Cohort Study on Antibiotic Resistance and Treatment Options

Eliyahu Adhehani et al. Pediatr Infect Dis J. .

Abstract

Background: We characterized the microbiologic profiles and antibiotic resistance patterns of bacteria isolated from pediatric patients with appendicitis and assessed the influence of demographic and clinical factors on these profiles.

Methods: This retrospective cohort study was conducted between 2019 and 2021 at the Soroka University Medical Center (SUMC). Data were collected on the demographic characteristics, clinical presentation, risk factors and surgical interventions of children diagnosed with appendicitis. Bacterial cultures obtained during the study period were analyzed to identify microbiological profiles, including species prevalence and patterns of antibiotic resistance.

Results: Overall, 379 participants were included. Surgical interventions included laparoscopic surgery, laparotomy or both in 53.6%, 44.9% and 1.6% of cases, respectively. Positive cultures accounted for 49.3% of samples; 18.4% with a single bacterium and 30.9% with polymicrobial growth. Among positive cultures, Escherichia coli was the most prevalent isolate (75.4%), followed by Bacteroides spp . (41.2%), Viridans Group Streptococci (VGS; 24.6%) and Pseudomonas (23.0%). Enterococcus was found in only 3.2% of positive cultures. Anaerobic bacteria collectively constituted 62.6% of isolates. Risk factors for antibiotic resistance, including previous hospitalization, surgery or antibiotic treatment within the last month/year, were identified in <10% of cases. E. coli exhibited high susceptibility rates for gentamicin and ceftazidime (both 90.1%), ceftriaxone (89.4%) and carbapenems (100.0%). Susceptibility was lower for TMP/SMX (66.7%) and ampicillin (27.7%). Pseudomonas spp. isolates were susceptible to meropenem, ciprofloxacin (100.0%) and gentamicin (96.3%). For VGS, susceptibility to ceftriaxone and vancomycin was 100.0%, for penicillin 96.3%, and 92.6% for clindamycin and erythromycin.

Conclusions: Antibiotic treatment for pediatric appendicitis should primarily target E. coli and anaerobes. Pseudomonas and VGS are present in ~25% of cultures. In a previously healthy population with low rates of risk factors for antibiotic resistance, empiric treatment with an aminoglycoside to cover E. coli and pseudomonas , and metronidazole to cover anaerobes is adequate.

Keywords: antibiotic resistance; appendicitis; treatment guidelines.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

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