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Peritoneal cultures and antibiotic treatment in patients with perforated appendicitis
1The Department of Surgery B, Tel-Aviv Sourasky Medical Centre and the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Objective:
To question the common practice of sending material for microbiological examination during appendicectomy for perforated appendixes.
Design:
Uncontrolled retrospective study.
Setting:
Teaching hospital, Israel.
Subjects:
89 patients who had their perforated appendixes removed.
Interventions:
Appendicectomy and antibiotic treatment.
Main Outcome Measure:
Whether a change in antibiotic regimen was required after bacteriological identification of bacteria isolated during the operation.
Results:
In only 43 of the cultures (48%) taken during the operation were bacteria grown, and these were mainly Escherichia coli. In 65 patients (73%) there was no need to change the previously initiated antibiotic regimen, and in 23 (26%) it was changed purely on clinical grounds. In only one patient (1%) was the change the consequence of microbiological testing, as the organisms identified in 42 of the 43 cultures (98%) were sensitive to at least one of the antibiotics that had already been given.
Conclusion:
The practice of culturing samples taken from a ruptured appendix is redundant, because the antibiotic that has already been initiated is effective in most of the patients and the decision to modify the therapeutic regimen is dominated by clinical considerations.
Insights
Routine microbiological examination of ruptured appendix samples is unnecessary. Initial antibiotic treatment is effective in most cases, making cultures redundant for guiding therapy in appendicitis.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Microbiology
Background:
- Appendicectomy is a common surgical procedure.
- Perforated appendicitis necessitates prompt antibiotic treatment.
- Current practice often includes microbiological examination of surgical specimens.
Purpose of the Study:
- To evaluate the clinical utility of routine microbiological examination of samples from perforated appendixes.
- To determine if intraoperative cultures impact antibiotic regimen selection.
Main Methods:
- Retrospective analysis of 89 patients undergoing appendicectomy for perforated appendix.
- Review of intraoperative cultures and subsequent antibiotic treatment adjustments.
- Uncontrolled study design in a teaching hospital setting.
Main Results:
- Bacteria were cultured in only 48% of samples, predominantly Escherichia coli.
- Antibiotic regimens required no change in 73% of patients.
- Changes to antibiotic therapy were primarily driven by clinical assessment (26%), not microbiological results (1%).
Conclusions:
- Routine microbiological culturing of ruptured appendix specimens is not clinically indicated.
- Empirical antibiotic therapy is effective in the majority of perforated appendicitis cases.
- Clinical judgment, rather than culture data, should guide antibiotic modifications.