Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Bacterial culture and antibiotic susceptibility in patients with acute appendicitis

Abstract

Purpose

Essential treatment of acute appendicitis is surgical resection with the use of appropriate antibiotics. In order to effectively treat acute appendicitis, it is important to identify the microorganism of acute appendicitis and evaluate the effective antibiotics.

Methods

A total of 694 patients who underwent appendectomy for acute appendicitis and had positive microbial result between 2006 and 2015 were recruited. For microbial assessment, luminal contents of the appendix were swabbed after appendectomy. In patients with periappendiceal abscess, the specimens were obtained from abscess fluid. The patient characteristics, operative data, use of antibiotics, the results of microbiology, and postoperative morbidities including surgical site infection (SSI) were retrospectively reviewed.

Results

The mean age was 38.2 (± 19.8) years, and 422 patients (60.8%) were male. Most of the operations were performed by conventional laparoscopy (83.1%), followed by single-port laparoscopy (11.8%). The most common microorganism was Escherichia coli (64.6%), which was susceptible to amoxicillin/clavulanate, ciprofloxacin, most cephalosporins, piperacillin/tazobactam, and imipenem. The second most common microorganism was Pseudomonas aeruginosa (16.4%), which was resistant to amoxicillin/clavulanate and cefotaxime. The rate of postoperative morbidity was 8.6%, and the most common type was superficial SSI (6.2%), followed by ileus (1.2%), gastroenteritis (0.7%), and organ/space SSI (0.3%). P. aeruginosa (odds ratio = 2.128, 95% confidence interval 1.077–4.206, P = 0.030) was the only significant microorganism associated with SSI according to multivariate analysis adjusting for other clinical factors.

Conclusions

In perforated appendicitis, the use of empirical antibiotics seems to be safe. In some cases of Pseudomonas infection, adequate antibiotics should be considered.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Bennion RS, Baron EJ, Thompson JE Jr, Downes J, Summanen P, Talan DA, Finegold SM (1990) The bacteriology of gangrenous and perforated appendicitis—revisited. Ann Surg 211(2):165–171

  2. 2.

    Jeon HG, Ju HU, Kim GY, Jeong J, Kim MH, Jun JB (2014) Bacteriology and changes in antibiotic susceptibility in adults with community-acquired perforated appendicitis. PLoS One 9(10):e111144. https://doi.org/10.1371/journal.pone.0111144

  3. 3.

    Hansson J, Korner U, Khorram-Manesh A, Solberg A, Lundholm K (2009) Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg 96(5):473–481. https://doi.org/10.1002/bjs.6482

  4. 4.

    Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, Karoui M, Alves A, Dousset B, Valleur P, Falissard B, Franco D (2011) Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet 377(9777):1573–1579. https://doi.org/10.1016/s0140-6736(11)60410-8

  5. 5.

    Podda M, Cillara N, Di Saverio S, Lai A, Feroci F, Luridiana G, Agresta F, Vettoretto N (2017) Antibiotics-first strategy for uncomplicated acute appendicitis in adults is associated with increased rates of peritonitis at surgery. A systematic review with meta-analysis of randomized controlled trials comparing appendectomy and non-operative management with antibiotics. Surgeon 15(5):303–314. https://doi.org/10.1016/j.surge.2017.02.001

  6. 6.

    Kim YH (2016) Conditional probability analysis of multidrug resistance in Gram-negative bacilli isolated from tertiary medical institutions in South Korea during 1999-2009. J Microbiol 54(1):50–56. https://doi.org/10.1007/s12275-016-5579-9

  7. 7.

    Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O'Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG (2010) 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. Surg Infect 11(1):79–109. https://doi.org/10.1089/sur.2009.9930

  8. 8.

    Lee SE, Choi YS, Kim BG, Cha SJ, Park JM, Chang IT (2014) Single port laparoscopic appendectomy in children using glove port and conventional rigid instruments. Annals of surgical treatment and research 86(1):35–38. https://doi.org/10.4174/astr.2014.86.1.35

  9. 9.

    Kang BM, Hwang JW, Ryu BY (2016) Single-port laparoscopic surgery in acute appendicitis: retrospective comparative analysis for 618 patients. Surg Endosc 30(11):4968–4975. https://doi.org/10.1007/s00464-016-4840-y

  10. 10.

    Park BK, Park JW, Ryoo SB, Jeong SY, Park KJ, Park JG (2015) Effect of visceral obesity on surgical outcomes of patients undergoing laparoscopic colorectal surgery. World J Surg 39(9):2343–2353. https://doi.org/10.1007/s00268-015-3085-6

  11. 11.

    Lee JW, Park JM, Lee SE, Park YG, Chi KC (2010) Bacteriologic study and antibiotics sensitivity of acute appendicitis treated with laparoscopic appendectomy. J Korean Surg Soc 79(5):369–376

  12. 12.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

  13. 13.

    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27(2):97–132

  14. 14.

    Chen CY, Chen YC, Pu HN, Tsai CH, Chen WT, Lin CH (2012) Bacteriology of acute appendicitis and its implication for the use of prophylactic antibiotics. Surg Infect 13(6):383–390. https://doi.org/10.1089/sur.2011.135

  15. 15.

    Rollins KE, Varadhan KK, Neal KR, Lobo DN (2016) Antibiotics versus appendicectomy for the treatment of uncomplicated acute appendicitis: an updated meta-analysis of randomised controlled trials. World J Surg 40(10):2305–2318. https://doi.org/10.1007/s00268-016-3561-7

  16. 16.

    Sallinen V, Akl EA, You JJ, Agarwal A, Shoucair S, Vandvik PO, Agoritsas T, Heels-Ansdell D, Guyatt GH, Tikkinen KA (2016) Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis. Br J Surg 103(6):656–667. https://doi.org/10.1002/bjs.10147

  17. 17.

    Salminen P, Paajanen H, Rautio T, Nordstrom P, Aarnio M, Rantanen T, Tuominen R, Hurme S, Virtanen J, Mecklin JP, Sand J, Jartti A, Rinta-Kiikka I, Gronroos JM (2015) Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA 313(23):2340–2348. https://doi.org/10.1001/jama.2015.6154

  18. 18.

    Kenig J, Richter P (2013) The need for culture swabs in laparoscopically treated appendicitis. Videosurgery and other miniinvasive techniques 8(4):310–314. https://doi.org/10.5114/wiitm.2011.35002

  19. 19.

    Obinwa O, Casidy M, Flynn J (2014) The microbiology of bacterial peritonitis due to appendicitis in children. Ir J Med Sci 183(4):585–591. https://doi.org/10.1007/s11845-013-1055-2

  20. 20.

    Aranda-Narvaez JM, Prieto-Puga Arjona T, Garcia-Albiach B, Montiel-Casado MC, Gonzalez-Sanchez AJ, Sanchez-Perez B, Titos-Garcia A, Santoyo-Santoyo J (2014) Post-appendectomy surgical site infection: overall rate and type according to open/laparoscopic approach. Enfermedades infecciosas y microbiologia clinica 32(2):76–81. https://doi.org/10.1016/j.eimc.2013.02.006

  21. 21.

    Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, Li ZZ, Wang H, Zhang H, Lin ZF, Lu JH, Yang T (2015) Surgical site infection after laparoscopic and open appendectomy: a multicenter large consecutive cohort study. Surg Endosc 29(6):1384–1393. https://doi.org/10.1007/s00464-014-3809-y

  22. 22.

    Coccolini F, D'Amico G, Sartelli M, Catena F, Montori G, Ceresoli M, Manfredi R, Di Saverio S, Ansaloni L (2016) Antibiotic resistance evaluation and clinical analysis of acute appendicitis; report of 1431 consecutive worldwide patients: a cohort study. Int J Surg 26:6–11. https://doi.org/10.1016/j.ijsu.2015.12.063

  23. 23.

    Lau YJ, Chen YH, Huang CT, Lee WS, Liu CY, Liu JW, Liu HD, Lee YJ, Chen CW, Ko WC, Hsueh PR (2012) Role of moxifloxacin for the treatment of community-acquired complicated intra-abdominal infections in Taiwan. J Microbiol Immunol Infect 45(1):1–6. https://doi.org/10.1016/j.jmii.2011.11.010

  24. 24.

    Soffer D, Zait S, Klausner J, Kluger Y (2001) Peritoneal cultures and antibiotic treatment in patients with perforated appendicitis. Eur J Surg 167(3):214–216. https://doi.org/10.1080/110241501750099456

  25. 25.

    Moawad MR, Dasmohapatra S, Justin T, Keeling N (2006) Value of intraoperative abdominal cavity culture in appendicectomy: a retrospective study. Int J Clin Pract 60(12):1588–1590. https://doi.org/10.1111/j.1742-1241.2005.00774

  26. 26.

    Aslan A, Karaveli C, Ogunc D, Elpek O, Karaguzel G, Melikoglu M (2007) Does noncomplicated acute appendicitis cause bacterial translocation? Pediatr Surg Int 23(6):555–558. https://doi.org/10.1007/s00383-007-1899-5

  27. 27.

    Davies HO, Alkhamesi NA, Dawson PM (2010) Peritoneal fluid culture in appendicitis: review in changing times. Int J Surg (London, England) 8(6):426–429. https://doi.org/10.1016/j.ijsu.2010.06.016

  28. 28.

    Kim JH, Kim HY, Park SK, Lee JS, Heo DS, Park SW, Lee YS (2015) Single-incision laparoscopic appendectomy versus conventional laparoscopic appendectomy: experiences from 1208 cases of single-incision laparoscopic appendectomy. Ann Surg 262(6):1054–1058. https://doi.org/10.1097/sla.0000000000001064

Download references

Funding

This research was supported by the Chung-Ang University Research Grants in 2017.

Author information

Correspondence to Byung Kwan Park.

Ethics declarations

This study was reviewed and approved by the institutional review board committee of the Chung-Ang University Hospital (IRB No. 1611-006-260).

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

Informed consent was not obtained but the presented data are anonymized and risk of identification is low.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Song, D.W., Park, B.K., Suh, S.W. et al. Bacterial culture and antibiotic susceptibility in patients with acute appendicitis. Int J Colorectal Dis 33, 441–447 (2018). https://doi.org/10.1007/s00384-018-2992-z

Download citation

Keywords

  • Appendicitis
  • Appendectomy
  • Microbiology
  • Adverse effects
  • Surgical wound infection