Perforated appendicitis in children: antimicrobial susceptibility and antimicrobial stewardship.

Autor: Turel O; Department of Pediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey. Electronic address: barisbulent98@yahoo.com., Mirapoglu SL; Department of Pediatric Surgery, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey., Yuksel M; Department of Pediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey., Ceylan A; Department of Microbiology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey., Gultepe BS; Department of Microbiology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: Journal of global antimicrobial resistance [J Glob Antimicrob Resist] 2019 Mar; Vol. 16, pp. 159-161. Date of Electronic Publication: 2018 Sep 27.
DOI: 10.1016/j.jgar.2018.09.015
Abstrakt: Objectives: For perforated appendicitis in children, microbiological cultures should always be sought if an adequate sample is available. Knowledge of local epidemiology is important for optimal selection of antimicrobial therapy. The aim of this study was to evaluate the aetiology and susceptibility of pathogens in paediatric patients with perforated appendicitis.
Methods: Microbiological results of tissue samples obtained at surgery from children with acute appendicitis over 24 months were evaluated retrospectively.
Results: Among 209 children operated for acute appendicitis, 62 (29.7%) were perforated appendicitis. Intraperitoneal culture results were available for 42 patients, of which 41 (97.6%) had positive microbiological growth (57 pathogens). The male:female ratio was 1.8 and the mean age at presentation was 11 years (range 4-18 years). The most common pathogen was Escherichia coli (66.7%), among which 57.9% produced an extended-spectrum β-lactamase (ESBL). All patients received initial treatment with intravenous antibiotics (ampicillin, gentamicin and metronidazole). The antibiotic regimen was modified in 22 patients (52.4%). Seven patients (16.7%) developed a post-operative complication. No significant difference was observed for development of complications between patients with ESBL-positive and -negative E. coli growth (P=0.698).
Conclusion: The high rate of ESBL-positive E. coli may indicate bowel colonisation with resistant bacteria even in the community setting. Prospective studies will show whether treatment options should be directed according to identified pathogens.
(Copyright © 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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