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Bacterial studies of peritoneal cavity and postoperative surgical wound drainage following perforated appendix in
Insights
Bacterial infections in children with ruptured appendix are polymicrobial, involving both aerobic and anaerobic bacteria. Many of these bacteria produce beta-lactamase, an enzyme that can resist common antibiotics.
Area of Science:
- Microbiology
- Pediatric Surgery
- Infectious Diseases
Background:
- Appendicitis is a common surgical emergency in children.
- Perforation of the appendix can lead to intra-abdominal infection and complications like surgical site infections.
- Understanding the microbial flora in these infections is crucial for effective treatment.
Purpose of the Study:
- To characterize the aerobic and anaerobic bacterial isolates from the peritoneal cavity of children with perforated appendicitis.
- To identify bacteria present in postoperative surgical draining wounds in these patients.
- To assess the prevalence of beta-lactamase production in the isolated bacteria.
Main Methods:
- Bacterial specimens were collected from the peritoneal fluid of 112 children with ruptured appendix.
- Samples from postoperative draining wounds of 11 patients were also analyzed.
- Bacterial isolates were identified, and their susceptibility to beta-lactamase was tested.
Main Results:
- Bacterial growth was observed in 100 peritoneal fluid specimens, with 74 showing mixed aerobic and anaerobic flora.
- Predominant aerobic isolates included Escherichia coli and various streptococci.
- Predominant anaerobic isolates included Bacteroides spp. (especially B. fragilis group) and gram-positive anaerobic cocci.
- Beta-lactamase production was detected in 98 isolates from 74 patients, including all B. fragilis isolates.
- Similar polymicrobial flora, including B. fragilis and E. coli, were found in surgical wound infections.
Conclusions:
- Perforated appendicitis in children is characterized by polymicrobial aerobic and anaerobic peritoneal and wound infections.
- Beta-lactamase-producing organisms are prevalent in these infections, impacting antibiotic choices.
- Targeted antibiotic therapy considering beta-lactamase activity is essential for managing these complex infections.
Abstract:
This study reports bacterial specimens obtained from 112 children presenting with a ruptured appendix. Additional samples were studied from 11 of these patients who developed a postoperative surgical draining wound. Bacterial growth occurred in 100 peritoneal fluid specimens. Anaerobic bacteria alone were present in 14 specimens, aerobes alone in 12, and mixed aerobic an anerobic flora in 74 specimens. There were 144 aerobic isolates (1.4 per specimen). The predominant isolates were: E. coli (57 specimens); alpha-hemolytic steptococcus (16 specimens); gamma-hemolytic streptococcus (15 specimens); Group D streptococcus (12 specimens); and P. aeruginosa (9 specimens). There were 301 anaerobic isolates (three per specimen). The predominant isolates were: 157 Bacteroides spp. (including 92 B. fragilis group and 26 B. melaninogenicus group); 62 gram-positive anaerobic cocci (including 30 Peptococcus sp.; 29 Peptostreptococcus sp.); 27 Fusobactenium sp.; and 16 Clostridium sp. B. fragilis and Peptococcus sp. occurred in 23 patients. Beta lactamase production was detectable in 98 isolates recovered from 74 patients. These included all isolates of B. fragilis and six of the 23 Bacteroides sp. Forty-nine organisms (16 aerobic and 33 anaerobic) were recovered from the draining wounds. The predominant organisms were: B. fragilis (8 specimens); E. coli (6 specimens); Peptostreptococcus sp. (5 specimens); and three specimens each of P. aeruginosa and Peptococcus sp. Most of these isolates were also recovered from the peritoneal cavity of the patients. These findings demonstrate the polymicrobial aerobic and anaerobic nature of peritoneal cavity and postoperative wound flora in children with perforated appendix, and demonstrate the presence of beta lactamase-producing organisms in three-fourths of the patients.