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Differences in isolated bacteria between perforated and non-perforated appendicitis: an analysis of 680 consecutive appendicectomies in a single institution

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Abstract

Purpose

Escherichia coli and Bacteroides species are the most frequently detected species in ascites in perforated appendicitis and are generally sensitive to non-empiric cephalosporins like cefazolin or cefmetazole. However, monotherapy with such antibiotics is mostly insufficient for perforated appendicitis. To investigate this issue, this study aimed to compare bacterial floras in ascites culture between perforated and non-perforated appendicitis.

Methods

Ascites culture results in perforated and non-perforated appendicitis cases were analyzed using a departmental database. The duration of symptoms before surgery, pre-surgical white blood cell count, C-reactive protein value, postsurgical length of stay, length of antibiotic treatment, and the rate of using second-line antibiotics or complications were also compared.

Results

A total of 608 and 72 cases of non-perforated and perforated appendicitis were included. Escherichia coli and Bacteroides species were the dominant bacteria in both conditions. However, the total proportions of Pseudomonas aeruginosa, Streptococcus anginosus group, and Enterococcus group were significantly higher in perforated appendicitis than in non-perforated appendicitis.

Conclusion

Pseudomonas aeruginosa, Streptococcus anginosus group, and Enterococcus group have better susceptibility to penicillin-based empiric antibiotics than cephalosporins. The abundance of these bacteria might explain why non-empiric cephalosporins are not effective in perforated appendicitis and the superiority of penicillin-based empiric antibiotics.

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Acknowledgements

We thank Ellen Knapp, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

No specific funding was acquired for this study.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Kanazawa Medical University, Daigaku 1-1, Uchinada, Kahoku, Ishikawa, 9200293, Japan

    Ryo Tamura, Kiyokuni Nakamura, Taichi Hirotani, Yoshitomo Yasui & Hideaki Okajima

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  1. Ryo Tamura
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  2. Kiyokuni Nakamura
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  3. Taichi Hirotani
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  4. Yoshitomo Yasui
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  5. Hideaki Okajima
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by Ryo Tamura. The first draft of the manuscript was written by Ryo Tamura and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ryo Tamura.

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Tamura, R., Nakamura, K., Hirotani, T. et al. Differences in isolated bacteria between perforated and non-perforated appendicitis: an analysis of 680 consecutive appendicectomies in a single institution. Pediatr Surg Int 38, 1887–1893 (2022). https://doi.org/10.1007/s00383-022-05236-6

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  • DOI: https://doi.org/10.1007/s00383-022-05236-6

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