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Is Pseudomonas infection associated with worse outcomes in pediatric perforated appendicitis?
Christina M Theodorou1, Sarah C Stokes1, Mennatalla S Hegazi1
1University of California Davis Medical Center, Department of Pediatric General, Thoracic, and Fetal Surgery, Sacramento, CA, USA.
Insights
Pseudomonas infection in children with perforated appendicitis did not increase organ-space infections. However, it was linked to longer hospital stays and antibiotic use, suggesting current empiric antibiotic regimens may not need Pseudomonas coverage.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Microbiology
Background:
- Limited data exists on Pseudomonas infections in pediatric perforated appendicitis.
- Pseudomonas is often not covered by standard empiric antibiotic protocols for appendicitis.
- This study investigates the impact of Pseudomonas on clinical outcomes in this patient population.
Purpose of the Study:
- To determine the effect of Pseudomonas infection on post-operative outcomes in children with perforated appendicitis.
- To evaluate if Pseudomonas presence necessitates changes in empiric antibiotic strategies.
Main Methods:
- A retrospective study included children under 18 who underwent appendectomy for perforated appendicitis (2015-2019).
- Patients were stratified based on the presence of Pseudomonas in intraoperative cultures.
- The primary outcome measured was post-operative organ-space surgical site infection (SSI).
Main Results:
- Pseudomonas was identified in 22.2% of perforated appendicitis cases.
- Rates of organ-space SSI were similar between children with (21.2%) and without (20.7%) Pseudomonas.
- Children with Pseudomonas experienced longer antibiotic durations (9.1 vs. 6.7 days) and hospital length of stay (LOS) (6.7 vs. 5.9 days).
- No significant differences were observed in post-operative interventions, hospital costs, ED visits, or readmissions.
Conclusions:
- Pseudomonas infection in pediatric perforated appendicitis is associated with increased antibiotic duration and LOS.
- Despite these differences, Pseudomonas did not correlate with higher rates of surgical site infections or other major adverse outcomes.
- Current empiric antibiotic coverage for Pseudomonas in perforated appendicitis may not be necessary.
Background:
There is little information on the effects of Pseudomonas infection on outcomes in perforated appendicitis. As Pseudomonas is not covered by many empiric appendicitis antibiotic regiments, we hypothesized that children with Pseudomonas would have worse outcomes.
Methods:
Patients <18 years old undergoing appendectomy for perforated appendicitis at a tertiary children's hospital 2015-2019 were included and were stratified by presence of Pseudomonas on intraoperative culture. The primary outcome was post-operative organ-space infection (SSI).
Results:
Intraoperative cultures were collected in 58.4% of patients (n = 149/255) with 22.2% (n = 33) positive for Pseudomonas. SSIs occurred in 21.2% of children with Pseudomonas compared to 20.7% of children without Pseudomonas (p = 0.9). Children with Pseudomonas had longer antibiotic duration (9.1 vs. 6.7 days, p = 0.03) and LOS (6.7 vs. 5.9 days, p = 0.03) than those without, but a similar rate of post-operative interventions (12.2% vs. 19.0%, p = 0.4), hospital costs ($28,860 vs. $23,945, p = 0.3), ED visits (9.1% vs. 19.9%, p = 0.3), and readmissions (9.1% vs. 9.5%, p = 1).
Conclusion:
Pseudomonas was identified in 22% children with perforated appendicitis and was associated with longer antibiotic durations and LOS, but similar rates of SSI, post-operative interventions, and readmissions compared to children without Pseudomonas. Empiric coverage of Pseudomonas may not be necessary.
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