Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Optimal First-Line Antibiotic Treatment for Pediatric Complicated Appendicitis Based on Peritoneal Fluid Culture

  • Aiyoshi, Tsubasa (Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba) ;
  • Masumoto, Kouji (Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba) ;
  • Tanaka, Nao (Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba) ;
  • Sasaki, Takato (Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba) ;
  • Chiba, Fumiko (Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba) ;
  • Ono, Kentaro (Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba) ;
  • Jimbo, Takahiro (Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba) ;
  • Urita, Yasuhisa (Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba) ;
  • Shinkai, Toko (Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba) ;
  • Takayasu, Hajime (Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba) ;
  • Hitomi, Shigemi (Department of Infectious Diseases, Faculty of Medicine, University of Tsukuba)
  • Received : 2021.06.09
  • Accepted : 2021.09.05
  • Published : 2021.11.15
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Abstract

Purpose: Consensus is lacking regarding the optimal antibiotic treatment for pediatric complicated appendicitis. This study determined the optimal first-line antibiotic treatment for pediatric patients with complicated appendicitis based on peritoneal fluid cultures. Methods: This retrospective study examined the cases of pediatric patients who underwent appendectomy for complicated appendicitis at our institution between 2013 and 2019. Peritoneal fluid specimens obtained during appendectomy were cultured for the presence of bacteria. Results: Eighty-six pediatric patients were diagnosed with complicated appendicitis. Of them, bacteria were identified in 54 peritoneal fluid samples. The major identified bacteria were Escherichia coli (n=36 [66.7%]), Bacteroides fragilis (n=28 [51.9%]), α-Streptococcus (n=25 [46.3%]), Pseudomonas aeruginosa (n=10 [18.5%]), Enterococcus avium (n=9 [16.7%]), γ-Streptococcus (n=9 [16.7%]), and Klebsiella oxytoca (n=6 [11.1%]). An antibiotic susceptibility analysis showed E. coli was inhibited by sulbactam/ampicillin in 43.8% of cases versus cefmetazole in 100% of cases. Tazobactam/piperacillin and meropenem inhibited the growth of 96.9-100% of the major identified bacteria. E. coli (100% vs. 84.6%) and P. aeruginosa (100% vs. 80.0%) were more susceptible to amikacin than gentamicin. Conclusion: Tazobactam/piperacillin or meropenem is a reasonable first-line antibiotic treatment for pediatric complicated appendicitis. In the case of aminoglycoside use, amikacin is recommended.

Keywords

References

  1. Hadley GP. Intra-abdominal sepsis--epidemiology, aetiology and management. Semin Pediatr Surg 2014;23:357-62. https://doi.org/10.1053/j.sempedsurg.2014.06.008
  2. Jimbo T, Masumoto K, Takayasu H, Shinkai T, Urita Y, Uesugi T, et al. Outcome of early discharge protocol after appendectomy for pediatric acute appendicitis. Pediatr Int 2017;59:803-6. https://doi.org/10.1111/ped.13290
  3. Centers for Disease Control and Prevention (CDC). Surgical site infection (SSI) event: procedureassociated module [Internet]. Atlanta (GA): CDC; 2016 [cited 2018 Sep 11]. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf.
  4. David IB, Buck JR, Filler RM. Rational use of antibiotics for perforated appendicitis in childhood. J Pediatr Surg 1982;17:494-500. https://doi.org/10.1016/S0022-3468(82)80096-1
  5. Elmore JR, Dibbins AW, Curci MR. The treatment of complicated appendicitis in children. What is the gold standard? Arch Surg 1987;122:424-7. https://doi.org/10.1001/archsurg.1987.01400160050006
  6. Neilson IR, Laberge JM, Nguyen LT, Moir C, Doody D, Sonnino RE, et al. Appendicitis in children: current therapeutic recommendations. J Pediatr Surg 1990;25:1113-6. https://doi.org/10.1016/0022-3468(90)90742-R
  7. Lund DP, Murphy EU. Management of perforated appendicitis in children: a decade of aggressive treatment. J Pediatr Surg 1994;29:1130-3; discussion 1133-4. https://doi.org/10.1016/0022-3468(94)90294-1
  8. Kaplan S. Antibiotic usage in appendicitis in children. Pediatr Infect Dis J 1998;17:1047-8. https://doi.org/10.1097/00006454-199811000-00019
  9. Emil S, Laberge JM, Mikhail P, Baican L, Flageole H, Nguyen L, et al. Appendicitis in children: a ten-year update of therapeutic recommendations. J Pediatr Surg 2003;38:236-42. https://doi.org/10.1053/jpsu.2003.50052
  10. Uhari M, Seppanen J, Heikkinen E. Imipenem-cilastatin vs. tobramycin and metronidazole for appendicitis-related infections. Pediatr Infect Dis J 1992;11:445-50. https://doi.org/10.1097/00006454-199206000-00005
  11. Ciftci AO, Tanyel FC, Buyukpamukcu N, Hicsonmez A. Comparative trial of four antibiotic combinations for perforated appendicitis in children. Eur J Surg 1997;163:591-6.
  12. Fishman SJ, Pelosi L, Klavon SL, O'Rourke EJ. Perforated appendicitis: prospective outcome analysis for 150 children. J Pediatr Surg 2000;35:923-6. https://doi.org/10.1053/jpsu.2000.6924
  13. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010;50:133-64. https://doi.org/10.1086/649554
  14. Mazuski JE, Tessier JM, May AK, Sawyer RG, Nadler EP, Rosengart MR, et al. The Surgical Infection Society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt) 2017;18:1-76. https://doi.org/10.1089/sur.2016.261
  15. Hopkins JA, Lee JC, Wilson SE. Susceptibility of intra-abdominal isolates at operation: a predictor of postoperative infection. Am Surg 1993;59:791-6.
  16. Schmitt F, Clermidi P, Dorsi M, Cocquerelle V, Gomes CF, Becmeur F. Bacterial studies of complicated appendicitis over a 20-year period and their impact on empirical antibiotic treatment. J Pediatr Surg 2012;47:2055-62. https://doi.org/10.1016/j.jpedsurg.2012.04.025
  17. Kobayashi M, Inoue Y, Mohri Y, Miki C, Kusunoki M. Implementing a standard protocol to decrease the incidence of surgical site infections in rectal cancer surgery. Surg Today 2010;40:326-33. https://doi.org/10.1007/s00595-008-4075-1
  18. Shimizu J, Ikeda K, Fukunaga M, Murata K, Miyamoto A, Umeshita K, et al. Multicenter prospective randomized phase II study of antimicrobial prophylaxis in low-risk patients undergoing colon surgery. Surg Today 2010;40:954-7. https://doi.org/10.1007/s00595-009-4176-5
  19. Yamaguchi K, Ishii Y, Tateda K, Iwata M, Watanabe N, Shinagawa M, et al. [Nationwide surveillance of parenteral antibiotics containing meropenem activities against clinically isolated strains in 2012]. Jpn J Antibiot 2014;67:73-107. Japanese.
  20. Henry MC, Walker A, Silverman BL, Gollin G, Islam S, Sylvester K, et al. Risk factors for the development of abdominal abscess following operation for perforated appendicitis in children: a multicenter case-control study. Arch Surg 2007;142:236-41; discussion 241. https://doi.org/10.1001/archsurg.142.3.236
  21. St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D, et al. Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg 2012;256:581-5. https://doi.org/10.1097/SLA.0b013e31826a91e5
  22. Boueil A, Guegan H, Colot J, D'Ortenzio E, Guerrier G. Peritoneal fluid culture and antibiotic treatment in patients with perforated appendicitis in a Pacific Island. Asian J Surg 2015;38:242-6. https://doi.org/10.1016/j.asjsur.2015.03.005
  23. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002;34:730-51. https://doi.org/10.1086/339215
  24. Guillet-Caruba C, Cheikhelard A, Guillet M, Bille E, Descamps P, Yin L, et al. Bacteriologic epidemiology and empirical treatment of pediatric complicated appendicitis. Diagn Microbiol Infect Dis 2011;69:376-81. https://doi.org/10.1016/j.diagmicrobio.2010.11.003
  25. Fallon SC, Hassan SF, Larimer EL, Rodriguez JR, Brandt ML, Wesson DE, et al. Modification of an evidence-based protocol for advanced appendicitis in children. J Surg Res 2013;185:273-7. https://doi.org/10.1016/j.jss.2013.05.088
  26. Dahlberg M, Almstrom M, Wester T, Svensson JF. Intraoperative cultures during appendectomy in children are poor predictors of pathogens and resistance patterns in cultures from postoperative abscesses. Pediatr Surg Int 2019;35:341-6. https://doi.org/10.1007/s00383-018-04428-3
  27. The SML, Bakx R, Budding AE, de Meij TGJ, van der Lee JH, Bunders MJ, et al. Microbiota of children with complex appendicitis: different composition and diversity of the microbiota in children with complex compared with simple appendicitis. Pediatr Infect Dis J 2019;38:1054-60. https://doi.org/10.1097/inf.0000000000002434
  28. Swidsinski A, Dorffel Y, Loening-Baucke V, Theissig F, Ruckert JC, Ismail M, et al. Acute appendicitis is characterised by local invasion with Fusobacterium nucleatum/necrophorum. Gut 2011;60:34-40. https://doi.org/10.1136/gut.2009.191320
  29. Zhong D, Brower-Sinning R, Firek B, Morowitz MJ. Acute appendicitis in children is associated with an abundance of bacteria from the phylum Fusobacteria. J Pediatr Surg 2014;49:441-6. https://doi.org/10.1016/j.jpedsurg.2013.06.026
  30. Jackson HT, Mongodin EF, Davenport KP, Fraser CM, Sandler AD, Zeichner SL. Culture-independent evaluation of the appendix and rectum microbiomes in children with and without appendicitis. PLoS One 2014;9:e95414. https://doi.org/10.1371/journal.pone.0095414