Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study
BackgroundAppendicitis is a frequent condition, with peak incidences in the second decade of life. Its pathogenesis is under debate, but bacterial infections are crucial, and antibiotic treatment remains essential. Rare bacteria are accused of causing complications, and various calculated antibiotic...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Cellular and Infection Microbiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcimb.2023.1027769/full |
| _version_ | 1797830917252710400 |
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| author | Julia Felber Benedikt Gross Arend Rahrisch Eric Waltersbacher Evelyn Trips Percy Schröttner Guido Fitze Jurek Schultz |
| author_facet | Julia Felber Benedikt Gross Arend Rahrisch Eric Waltersbacher Evelyn Trips Percy Schröttner Guido Fitze Jurek Schultz |
| author_sort | Julia Felber |
| collection | DOAJ |
| description | BackgroundAppendicitis is a frequent condition, with peak incidences in the second decade of life. Its pathogenesis is under debate, but bacterial infections are crucial, and antibiotic treatment remains essential. Rare bacteria are accused of causing complications, and various calculated antibiotics are propagated, yet there is no comprehensive microbiological analysis of pediatric appendicitis. Here we review different pre-analytic pathways, identify rare and common bacterial pathogens and their antibiotic resistances, correlate clinical courses, and evaluate standard calculated antibiotics in a large pediatric cohort.MethodWe reviewed 579 patient records and microbiological results of intraoperative swabs in standard Amies agar media or fluid samples after appendectomies for appendicitis between May 2011 and April 2019. Bacteria were cultured and identified via VITEK 2 or MALDI-TOF MS. Minimal inhibitory concentrations were reevaluated according to EUCAST 2022. Results were correlated to clinical courses.ResultsOf 579 analyzed patients, in 372 patients we got 1330 bacterial growths with resistograms. 1259 times, bacteria could be identified to species level. 102 different bacteria could be cultivated. 49% of catarrhal and 52% of phlegmonous appendices resulted in bacterial growth. In gangrenous appendicitis, only 38% remained sterile, while this number reduced to 4% after perforation. Many fluid samples remained sterile even when unsterile swabs had been taken simultaneously. 40 common enteral genera were responsible for 76.5% of bacterial identifications in 96.8% of patients. However, 69 rare bacteria were found in 187 patients without specifically elevated risk for complications.ConclusionAmies agar gel swabs performed superior to fluid samples and should be a standard in appendectomies. Even catarrhal appendices were only sterile in 51%, which is interesting in view of a possible viral cause. According to our resistograms, the best in vitro antibiotic was imipenem with 88.4% susceptible strains, followed by piperacillin-tazobactam, cefuroxime with metronidazole, and ampicillin-sulbactam to which only 21.6% of bacteria were susceptible. Bacterial growths and higher resistances correlate to an elevated risk of complications. Rare bacteria are found in many patients, but there is no specific consequence regarding antibiotic susceptibility, clinical course, or complications. Prospective, comprehensive studies are needed to further elicit pediatric appendicitis microbiology and antibiotic treatment. |
| first_indexed | 2024-04-09T13:43:57Z |
| format | Article |
| id | doaj.art-5e6eb54a05e84017947f9cd447861a58 |
| institution | Directory Open Access Journal |
| issn | 2235-2988 |
| language | English |
| last_indexed | 2024-04-09T13:43:57Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cellular and Infection Microbiology |
| spelling | doaj.art-5e6eb54a05e84017947f9cd447861a582023-05-09T05:40:00ZengFrontiers Media S.A.Frontiers in Cellular and Infection Microbiology2235-29882023-05-011310.3389/fcimb.2023.10277691027769Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective studyJulia Felber0Benedikt Gross1Arend Rahrisch2Eric Waltersbacher3Evelyn Trips4Percy Schröttner5Guido Fitze6Jurek Schultz7Department of Pediatric Surgery, University Hospital Dresden – Technical University of Dresden, Dresden, GermanyDepartment of Pediatric Surgery, University Hospital Dresden – Technical University of Dresden, Dresden, GermanyDepartment of Pediatric Surgery, University Hospital Dresden – Technical University of Dresden, Dresden, GermanyDepartment of Pediatric Surgery, University Hospital Dresden – Technical University of Dresden, Dresden, GermanyCoordination Centre for Clinical Trials, Faculty of Medicine Carl Gustav Carus, Technical University of Dresden, Dresden, GermanyInstitute for Microbiology and Virology, University Hospital Dresden – Technical University of Dresden, Dresden, GermanyDepartment of Pediatric Surgery, University Hospital Dresden – Technical University of Dresden, Dresden, GermanyDepartment of Pediatric Surgery, University Hospital Dresden – Technical University of Dresden, Dresden, GermanyBackgroundAppendicitis is a frequent condition, with peak incidences in the second decade of life. Its pathogenesis is under debate, but bacterial infections are crucial, and antibiotic treatment remains essential. Rare bacteria are accused of causing complications, and various calculated antibiotics are propagated, yet there is no comprehensive microbiological analysis of pediatric appendicitis. Here we review different pre-analytic pathways, identify rare and common bacterial pathogens and their antibiotic resistances, correlate clinical courses, and evaluate standard calculated antibiotics in a large pediatric cohort.MethodWe reviewed 579 patient records and microbiological results of intraoperative swabs in standard Amies agar media or fluid samples after appendectomies for appendicitis between May 2011 and April 2019. Bacteria were cultured and identified via VITEK 2 or MALDI-TOF MS. Minimal inhibitory concentrations were reevaluated according to EUCAST 2022. Results were correlated to clinical courses.ResultsOf 579 analyzed patients, in 372 patients we got 1330 bacterial growths with resistograms. 1259 times, bacteria could be identified to species level. 102 different bacteria could be cultivated. 49% of catarrhal and 52% of phlegmonous appendices resulted in bacterial growth. In gangrenous appendicitis, only 38% remained sterile, while this number reduced to 4% after perforation. Many fluid samples remained sterile even when unsterile swabs had been taken simultaneously. 40 common enteral genera were responsible for 76.5% of bacterial identifications in 96.8% of patients. However, 69 rare bacteria were found in 187 patients without specifically elevated risk for complications.ConclusionAmies agar gel swabs performed superior to fluid samples and should be a standard in appendectomies. Even catarrhal appendices were only sterile in 51%, which is interesting in view of a possible viral cause. According to our resistograms, the best in vitro antibiotic was imipenem with 88.4% susceptible strains, followed by piperacillin-tazobactam, cefuroxime with metronidazole, and ampicillin-sulbactam to which only 21.6% of bacteria were susceptible. Bacterial growths and higher resistances correlate to an elevated risk of complications. Rare bacteria are found in many patients, but there is no specific consequence regarding antibiotic susceptibility, clinical course, or complications. Prospective, comprehensive studies are needed to further elicit pediatric appendicitis microbiology and antibiotic treatment.https://www.frontiersin.org/articles/10.3389/fcimb.2023.1027769/fullpediatric appendicitisrare bacteriaanti-infective treatmentcomplicationsoutcome |
| spellingShingle | Julia Felber Benedikt Gross Arend Rahrisch Eric Waltersbacher Evelyn Trips Percy Schröttner Guido Fitze Jurek Schultz Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study Frontiers in Cellular and Infection Microbiology pediatric appendicitis rare bacteria anti-infective treatment complications outcome |
| title | Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study |
| title_full | Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study |
| title_fullStr | Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study |
| title_full_unstemmed | Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study |
| title_short | Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study |
| title_sort | bacterial pathogens in pediatric appendicitis a comprehensive retrospective study |
| topic | pediatric appendicitis rare bacteria anti-infective treatment complications outcome |
| url | https://www.frontiersin.org/articles/10.3389/fcimb.2023.1027769/full |
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