Intra-operative culture swabs in acute appendicitis: a waste of resources
F J Foo1, I J Beckingham, I Ahmed
1Department of General Surgery, Queen's Medical Centre, Nottingham NG7 2UH, UK.
Introduction:
Antibiotics gained a place in the management of acute appendicitis when the bacterial aetiology was demonstrated. Culture swabs were obtained routinely during appendicectomies to guide antibiotic use. Although current antimicrobial therapy use has become prophylactic, empirical and broad spectrum, this age-old practice still remains. Our study questions the value of this traditional practice.
Materials And Methods:
All adult and paediatric patients undergoing emergency appendicectomy over three years were retrospectively reviewed. Microbiology and appendix histology reports were retrieved. Occurrence of infective post-operative morbidity was recorded via hospital notes.
Results:
A total of 652 appendectomies (age 1 month to 81 years, median 20 years) were performed in a 36 month period. Four hundred and thirty-five/six hundred and fifty-two (66.7%) had intra-operative swabs taken. One hundred and forty/four hundred and thirty-five (32%) revealed presence ofa pathogens. One hundred and twenty-two/four hundred and thirty-five (28%) were sensitive to broad spectrum empirical antibiotics and only 18/435 (4.1%) cultured resistant strains. Forty-two/six-hundred and fifty-two (6.4%) patients had postoperative infective complications. Twenty-nine/forty-two (68%) had a different organism responsible for this complication. The highest proportion of positive cultures and post-operative infective complications was observed in the extremes of ages (< 10 and > 50 years) and in gangrenous appendicitis.
Conclusion:
A majority of intra-operative swabs were negative or isolated commensal flora. Pathogens causing postoperative morbidity were frequently different from those isolated intra-operatively. None of the patients had a change of management based on the swab results. Hence routine intra-peritoneal swabs remains of little clinical value.
Insights
Routine intra-operative swabs in appendectomies offer little clinical value. Most swabs are negative or show normal flora, and pathogens causing complications often differ from intra-operative findings.
Area of Science:
- Surgery
- Infectious Diseases
- Microbiology
Background:
- Antibiotic use in acute appendicitis management is guided by bacterial etiology.
- Routine intra-operative culture swabs during appendectomies have been a traditional practice.
- Current antimicrobial therapy is often prophylactic, empirical, and broad-spectrum.
Purpose of the Study:
- To evaluate the clinical utility of routine intra-operative culture swabs in appendectomies.
- To determine if intra-operative swab results influence patient management or outcomes.
- To assess the correlation between intra-operative microbial findings and post-operative infective morbidity.
Main Methods:
- Retrospective review of adult and pediatric patients undergoing emergency appendectomy over three years.
- Retrieval of microbiology and appendix histology reports.
- Recording of post-operative infective morbidity from hospital records.
Main Results:
- 66.7% of appendectomies had intra-operative swabs taken; 32% yielded pathogens.
- Only 4.1% of cultured strains were resistant to broad-spectrum empirical antibiotics.
- Post-operative infective complications occurred in 6.4% of patients, often due to different organisms.
Conclusions:
- The majority of intra-operative swabs were negative or showed commensal flora.
- Pathogens causing post-operative morbidity frequently differed from intra-operative isolates.
- Routine intra-peritoneal swabs demonstrated little clinical value, with no change in management observed based on results.
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