Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial management
Abstract Background Appendicitis remains a common surgical emergency in children. Empirical antibacterial treatment is indicated to reduce infective complications. We investigate the bacterial pathogens identified intra-operatively during appendectomies in children to guide empirical surgical antimi...
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Annals of Clinical Microbiology and Antimicrobials |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12941-023-00591-1 |
| _version_ | 1797811619848257536 |
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| author | Keir Bhaskar Simon Clarke Luke S. P. Moore Stephen Hughes |
| author_facet | Keir Bhaskar Simon Clarke Luke S. P. Moore Stephen Hughes |
| author_sort | Keir Bhaskar |
| collection | DOAJ |
| description | Abstract Background Appendicitis remains a common surgical emergency in children. Empirical antibacterial treatment is indicated to reduce infective complications. We investigate the bacterial pathogens identified intra-operatively during appendectomies in children to guide empirical surgical antimicrobial prophylaxis options. Methods A retrospective analysis of patients (< 18 years old) undergoing an appendectomy across a multisite London hospital (Nov 2019–March 2022) was undertaken. Patient-related outcomes including length of hospital stay (LOS), days of antibacterial therapy (DOT), intra-operative microbiology and post-operative radiology reports were interrogated. Results 304 patients underwent an appendectomy during this period; 39.1% of patients had intraoperative samples cultured. Bacterial pathogens were found in 73/119 (61.3%) cases; the most common isolates being Escherichia coli (42.0%), Pseudomonas aeruginosa (21.0%), milleri Streptococcus spp. (14.3%) and Bacteroides fragilis (5.9%). Polymicrobial infection was common (32/73). Isolation of Pseudomonas spp. from intra-operative sampling was associated with a greater LOS (7.0 vs. 5.0 days; p = 0.011) but nil effect on the incidence of postoperative collections. Presence of milleri Streptococcus spp. was associated with longer LOS (7.0 vs. 5.0 day; p = 0.007), DOT (12.0 vs. 8.5 day; p = 0.007) but had no observed outcome on postoperative collections (29.4% vs. 18.6%; p = 0.330). 48% of E. coli positive cultures were co-amoxiclav resistant and prolonged LOS compared to the non-resistant group (7.0 vs. 5.0 days; p = 0.040) but had no difference in post-operative collections (29.2% vs. 17.9%; p = 0.260). Conclusion A high proportion of children with appendicitis have Pseudomonas spp. isolated, leading to a prolonged LOS. Evolving Enterobacterales resistance and the presence of Pseudomonas spp. necessitate extended antibacterial coverage for paediatric appendectomies with evidence of peritonitis. |
| first_indexed | 2024-03-13T07:25:24Z |
| format | Article |
| id | doaj.art-7938e4f3d9d14833a8098b92b5e083f4 |
| institution | Directory Open Access Journal |
| issn | 1476-0711 |
| language | English |
| last_indexed | 2024-03-13T07:25:24Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Annals of Clinical Microbiology and Antimicrobials |
| spelling | doaj.art-7938e4f3d9d14833a8098b92b5e083f42023-06-04T11:23:21ZengBMCAnnals of Clinical Microbiology and Antimicrobials1476-07112023-06-012211810.1186/s12941-023-00591-1Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial managementKeir Bhaskar0Simon Clarke1Luke S. P. Moore2Stephen Hughes3Chelsea and Westminster NHS Foundation TrustChelsea and Westminster NHS Foundation TrustChelsea and Westminster NHS Foundation TrustChelsea and Westminster NHS Foundation TrustAbstract Background Appendicitis remains a common surgical emergency in children. Empirical antibacterial treatment is indicated to reduce infective complications. We investigate the bacterial pathogens identified intra-operatively during appendectomies in children to guide empirical surgical antimicrobial prophylaxis options. Methods A retrospective analysis of patients (< 18 years old) undergoing an appendectomy across a multisite London hospital (Nov 2019–March 2022) was undertaken. Patient-related outcomes including length of hospital stay (LOS), days of antibacterial therapy (DOT), intra-operative microbiology and post-operative radiology reports were interrogated. Results 304 patients underwent an appendectomy during this period; 39.1% of patients had intraoperative samples cultured. Bacterial pathogens were found in 73/119 (61.3%) cases; the most common isolates being Escherichia coli (42.0%), Pseudomonas aeruginosa (21.0%), milleri Streptococcus spp. (14.3%) and Bacteroides fragilis (5.9%). Polymicrobial infection was common (32/73). Isolation of Pseudomonas spp. from intra-operative sampling was associated with a greater LOS (7.0 vs. 5.0 days; p = 0.011) but nil effect on the incidence of postoperative collections. Presence of milleri Streptococcus spp. was associated with longer LOS (7.0 vs. 5.0 day; p = 0.007), DOT (12.0 vs. 8.5 day; p = 0.007) but had no observed outcome on postoperative collections (29.4% vs. 18.6%; p = 0.330). 48% of E. coli positive cultures were co-amoxiclav resistant and prolonged LOS compared to the non-resistant group (7.0 vs. 5.0 days; p = 0.040) but had no difference in post-operative collections (29.2% vs. 17.9%; p = 0.260). Conclusion A high proportion of children with appendicitis have Pseudomonas spp. isolated, leading to a prolonged LOS. Evolving Enterobacterales resistance and the presence of Pseudomonas spp. necessitate extended antibacterial coverage for paediatric appendectomies with evidence of peritonitis.https://doi.org/10.1186/s12941-023-00591-1MicrobiologyPaediatricsSurgeryApendicitis |
| spellingShingle | Keir Bhaskar Simon Clarke Luke S. P. Moore Stephen Hughes Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial management Annals of Clinical Microbiology and Antimicrobials Microbiology Paediatrics Surgery Apendicitis |
| title | Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial management |
| title_full | Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial management |
| title_fullStr | Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial management |
| title_full_unstemmed | Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial management |
| title_short | Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial management |
| title_sort | bacterial peritonitis in paediatric appendicitis microbial epidemiology and antimicrobial management |
| topic | Microbiology Paediatrics Surgery Apendicitis |
| url | https://doi.org/10.1186/s12941-023-00591-1 |
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