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Modification of an evidence-based protocol for advanced appendicitis in children
Sara C Fallon1, Saif F Hassan, Emily L Larimer
1Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
The Journal of Surgical Research
|July 10, 2013
Summary
Antibiotic resistance in children with advanced appendicitis is increasing. Peritoneal fluid cultures at surgery revealed 40% of patients had resistant bacteria, leading to a new recommended antibiotic therapy.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Microbiology
Background:
- An evidence-based clinical pathway for advanced appendicitis initially reduced infections and hospital stay.
- Four years post-implementation, infectious complications and antibiotic resistance increased.
- Prospective peritoneal fluid cultures were collected to optimize antibiotic therapy.
Purpose of the Study:
- To analyze peritoneal fluid microbiology in children with advanced appendicitis.
- To identify causative organisms and their antibiotic susceptibility.
- To guide empiric antibiotic therapy and reduce complication rates.
Main Methods:
- Prospective collection of peritoneal fluid cultures during appendectomy for advanced appendicitis.
- Microbiology analysis of isolates.
- Comparison of clinical and demographic data with a historic cohort.
- Statistical analysis using chi-squared, t-test, and Fisher exact test.
Main Results:
- No significant change in the intra-abdominal abscess rate (24-28%).
- Common isolates included Escherichia coli and Pseudomonas aeruginosa.
- 32% of isolates were Pseudomonas spp.; 12% were resistant to cefoxitin (Enterococcus spp. or E. coli).
Conclusions:
- 40% of children had organisms resistant or not susceptible to first-line antibiotics.
- Piperacillin-tazobactam is now recommended as empiric therapy.
- Peritoneal fluid analysis can guide tailored antibiotic treatment for advanced appendicitis.
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