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Impact of Percutaneous Drainage on Outcome of Intra-abdominal Infection Associated With Pediatric Perforated
William Bonadio1, Miriam Langer, Julie Cueva
1From the Departments of Emergency Medicine and Pediatrics, Maimonides Medical Center, Brooklyn, New York.
Insights
Medical management of perforated appendicitis with intra-abdominal infection (IAI) is often ineffective. Percutaneous drainage (PD) combined with antibiotics leads to rapid improvement in pediatric cases.
Area of Science:
- Pediatric surgery
- Infectious diseases
- Gastroenterology
Background:
- Perforated appendicitis can lead to severe complications and prolonged hospitalization.
- The optimal management strategy for perforated appendicitis with intra-abdominal infection (IAI) remains debated.
Purpose of the Study:
- To evaluate the effectiveness of medical management with parenteral antibiotics and percutaneous drainage (PD) for pediatric acute perforated appendicitis with IAI.
Main Methods:
- A review of 80 pediatric cases of acute perforated appendicitis with IAI treated with parenteral antibiotics and PD over 7 years.
- Analysis of hospitalization duration, IAI development, bacterial cultures, and post-hospitalization complications.
Main Results:
- Intra-abdominal infection (IAI) occurred in 60% on admission and 40% during hospitalization.
- Broad-spectrum antibiotics alone were often insufficient; 65% of IAI cases were polymicrobial, with Escherichia coli being the most common pathogen.
- Percutaneous drainage (PD) led to defervescence in 67% within 24 hours, though one-third experienced post-hospitalization complications.
Conclusions:
- Parenteral antibiotic therapy alone is frequently ineffective for resolving IAI in perforated appendicitis.
- Percutaneous drainage (PD) is a crucial component of management, often leading to rapid clinical improvement.
- Children with perforated appendicitis and IAI often face a complicated and prolonged clinical course.
Background:
Perforated appendicitis can result in potentially serious complications requiring prolonged medical care. The optimal approach to successfully managing this condition is controversial.
Methods:
Review of 80 consecutive cases of pediatric acute perforated appendicitis with intra-abdominal infection (IAI) medically managed with parenteral antibiotics and percutaneous drainage (PD) during a 7-year period.
Results:
All patients received broad spectrum parenteral antibiotic therapy. One-third were hospitalized for >2 weeks. IAI was identified on admission in 60% compared with developing during hospitalization in 40% of cases. Before performing PD, the mean duration of antibiotic therapy in those who developed IAI during hospitalization was 6 days. IAI cultures yielded 127 bacterial isolates; polymicrobial infection occurred in 65% of cases. Only 7% of aspirates were sterile. The most common pathogens were Escherichia coli (82%), of which 5 isolates exhibited extended-spectrum β-lactamase production, and streptococci (40%). At the time of PD, 60% were febrile (mean duration of in-hospital fever, 7.5 days); 67% defervesced within 24 hours after the procedure. Posthospitalization abdominal complications (recurrent IAI or appendicitis) occurred in one-third of patients.
Conclusions:
Children with perforated appendicitis and IAI often have a complicated and prolonged clinical course. Medical management consisting solely of parenteral antibiotic therapy is frequently ineffective in resolving IAI. Rapid clinical improvement commonly follows PD.
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