Selection of Appropriate Antibiotics Based on Peritoneal Fluid Culture in Pediatric Patients with Complicated Appendicitis

Abstract

Purpose : This study aimed to determine the appropriate antibiotics to treat complicated appendicitis in children based on peritoneal fluid cultures.

Methods : We retrospectively assessed 233 pediatric patients who underwent appendectomy at our institution between 2013 and 2017. Peritoneal fluid specimen was intraoperatively collected for culturing from 147 patients and studied bacteriologically.

Results : Sixty-five patients were diagnosed with complicated appendicitis. Bacteria were identified in 42 of those 65 patients based on peritoneal fluid culture obtained during appendectomy. The bacteria identified via culturing included Escherichia coli in 29 patients (69.0%) ; Bacteroides fragilis in 23 patients (54.8%) ; α-Streptococcus in 19 patients (45.2%) ; Pseudomonas aeruginosa in 9 patients (21.4%) ; and Enterococcus avium in 9 patients (21.4%). An antibiotic susceptibility analysis showed that sulbactam/ampicillin inhibited E. coli in 40.9% of cases and cefmetazole in 100%. Tazobactam/piperacillin and meropenem inhibited the growth of 95.4%-100% of the major identified bacteria. Bacteria were more susceptible to amikacin than to gentamicin : E. coli (amikacin : 100% vs. gentamicin : 79.3%) and P. aeruginosa (amikacin : 100% vs. gentamicin : 77.7%).

Conclusion : The present findings suggest that tazobactam/piperacillin or meropenem alone or in combination with amikacin is suitable for treating complicated appendicitis in children.