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The microbiology of bacterial peritonitis due to appendicitis in children

O Obinwa1, M Casidy, J Flynn

  • 1Department of Surgery, Portiuncula Hospital, Ballinasloe, Ireland, obinnaobinwa@rcsi.ie.

Irish Journal of Medical Science
|December 19, 2013
PubMed

Insights

This study found Escherichia coli and anaerobes are common in pediatric appendicitis peritonitis. Inadequate antibiotic treatment and resistant E. coli increase post-operative infections, guiding better antimicrobial strategies.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Microbiology

Background:

  • Secondary bacterial peritonitis is a complication of appendicitis.
  • Understanding the causative microorganisms and antibiotic susceptibility is crucial for effective treatment.

Purpose of the Study:

  • To investigate the microbiology of secondary bacterial peritonitis in pediatric appendicitis.
  • To evaluate the appropriateness of current antimicrobial practices.

Main Methods:

  • A 14-year retrospective single-centre study analyzed 69 pediatric patients with appendicitis-related peritonitis.
  • Peritoneal cultures, microbiology, antibiotic susceptibility, and post-operative outcomes were examined.

Main Results:

  • Escherichia coli (81%) and anaerobes (54%) were predominant. Amoxicillin-clavulanate resistance was noted in E. coli and anaerobes.
  • Pseudomonas aeruginosa and streptococci were less common and generally susceptible to standard antibiotics.
  • Current combination therapy (amoxicillin-clavulanate and aminoglycoside) is appropriate for 99% of cases; adding metronidazole ensures 100% coverage.

Conclusions:

  • E. coli and mixed anaerobes are key pathogens in pediatric appendicitis-related peritonitis.
  • Inadequate empirical antibiotics and amoxicillin-clavulanate resistant E. coli are linked to post-operative infections.
  • This study provides evidence for optimal combination therapy in pediatric bacterial peritonitis.
Abstract

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