Microbiology of uncomplicated and destructive appendicitis in children

Abstract

The purpose - to analyze bacteriological cultures from the abdominal cavity in various forms of appendicitis, to recommend a rational scheme of antibiotic prophylaxis and empirical therapy in children diagnosed with acute appendicitis.

Materials and methods. The study based on bacteriological cultures of the abdominal cavity contents of operated children (laparotomy and laparoscope) with acute appendicitis. Patients were treated in the surgical department of the Zhytomyr Regional Children’s Clinical Hospital in 1997-2020.

Results. We analyze 4255 (2334 children; 54.9% - positive) abdominal content cultures of children with acute appendicitis and its complications who were treated in the period 1997-2020. A total of 4965 children were treated, of which 31.3% of children underwent laparoscopic surgery. If we analyze by years, the number of laparoscopic appendectomies compared to 2001 increased by 57.34%.

In the microbiological aspect of simple appendicitis, the five leaders are: E. coli - sown in 57.97% of all positive results, Ent. faecalis - 13.36%, S. aureus - 7.6%, Klebsiella spp. - 5.76%, Str. spp - 5.63%. Whereas in destructive forms of appendicitis: E. coli - 57.83%, E. faecalis - 13.58%, Ps. aeruginosa - 8.95%, S. aureus - 8.68%, Str. spp - 3, 38%.

The structure of the isolated microflora in complicated appendicitis includes: S. aureus (8.03%), E. coli (48.7%), Ent. faecalis (28.3%), Ps. aeruginosa (7.8%), other pathogens - 7.17%. Cases of mixed infection in the focus of inflammation do not exceed 10.0%. The percentage of susceptibility of pathogens, which are most often sown from the abdominal cavity, to antibiotics in different periods of observation is different. It is important to remember that adequate antibacterial therapy should cover the anaerobic spectrum in destructive forms treatment. The widest range is protected by beta-lactams, carbapenems and chloramphenicol, but the use of the latter two groups is limited in pediatric practice, especially chloramphenicol due to its toxicity. You can create beneficial combinations of metronidazole, to which aerobes are not sensitive, together with cephalosporins, which in turn do not have clinically significant antianaerobic activity.

Conclusions. After analyzing the microbiological structure of simple and destructive appendicitis, it is advisable in each surgical hospital to study its own bacterial mirror. It is rational to attribute acute phlegmonous appendicitis without peritonitis to a simple (uncomplicated) form, and in the presence of peritonitis - to a destructive form of appendicitis. Simple and destructive forms of appendicitis have different microbiological picture. In the presence of postoperative complications in the microbiological picture, four pathogens are in the lead: E. coli, Ent. faecalis, S. aureus, Ps. aeruginosa. It is efficient to change treatment tactics, avoid monotherapy as such, in particular, cephalosporins, use more combinations, as well as use other groups of antibiotics, such as protected penicillins. Thus, we will be able to inhibit the growth of antibiotic resistance, reduce the frequency and intensity of postoperative complications, reduce the length of stay of the patient in the hospital.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all the institutions mentioned in the work. Informed consent was obtained from parents (or guardians).

No conflict of interests was declared by the authors.