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Pseudomonas aeruginosa as a primary pathogen in children with bacterial peritonitis
S C Aronoff1, M M Olson, M W Gauderer
1Department of Pediatrics, Case Western Reserve University, School of Medicine, Cleveland, OH.
Insights
This study compared sulbactam/ampicillin and clindamycin/gentamicin for bacterial peritonitis in children. Initial therapy for appendicitis-related peritonitis should target Pseudomonas aeruginosa due to its high prevalence.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Pharmacology
Background:
- Bacterial peritonitis in children, particularly those with appendicitis, presents a significant clinical challenge.
- Common pathogens include Escherichia coli and Bacteroides fragilis, with a notable prevalence of Pseudomonas aeruginosa.
Purpose of the Study:
- To compare the efficacy of sulbactam/ampicillin versus clindamycin/gentamicin in treating pediatric bacterial peritonitis.
- To evaluate the impact of Pseudomonas aeruginosa infections on treatment outcomes.
Main Methods:
- A prospective study involving 29 children with bacterial peritonitis, with 17 evaluable patients.
- Patients received either sulbactam/ampicillin/gentamicin or clindamycin/gentamicin.
- Microbiological analysis identified causative bacterial species, including common aerobic and anaerobic isolates.
Main Results:
- No significant differences were observed in age, sex, pathogen load, hospitalization duration, toxicity, or treatment failures between the two antibiotic groups.
- Children with Pseudomonas aeruginosa infections showed no difference in outcomes compared to controls.
- Pseudomonas aeruginosa was frequently isolated from peritoneal fluid in children with appendicitis.
Conclusions:
- Both sulbactam/ampicillin and clindamycin/gentamicin demonstrated comparable efficacy in treating pediatric bacterial peritonitis.
- Given the high prevalence of Pseudomonas aeruginosa in appendicitis-related peritonitis, initial antimicrobial regimens should include agents effective against this pathogen.
Abstract:
This prospective study compared the efficacy of sulbactam/ampicillin and clindamycin/gentamicin in the treatment of children with bacterial peritonitis. Of the 29 children enrolled, 17 were evaluable; eight received sulbactam/ampicillin/gentamicin and nine clindamycin/gentamicin. Sixteen patients were previously healthy children with appendicitis. An average of 3.6 bacterial species were recovered from the peritoneal fluid of each patient. E coli and B fragilis were the most common aerobic and anaerobic isolates, recovered from 15 and ten patients, respectively. Pseudomonas aeruginosa was recovered from seven of 17 children; the three children with P aeruginosa infections randomized to the sulbactam/ampicillin group received gentamicin in addition to the investigational agents throughout the treatment course. Although the study groups were small, there was no difference in age, sex, number of pathogens per patient, duration of hospitalization, toxicity, or treatment failures between the two treatment groups or between children infected with P aeruginosa and controls. As a result of the high prevalence of P aeruginosa in the peritoneal exudate of otherwise healthy children with appendicitis, initial antimicrobial therapy in this patient population should include agents effective against this organism.