Optimal First-Line Antibiotic Treatment for Pediatric Complicated Appendicitis Based on Peritoneal Fluid Culture

Tsubasa Aiyoshi; Kouji Masumoto; Nao Tanaka; Takato Sasaki; Fumiko Chiba; Kentaro Ono; Takahiro Jimbo; Yasuhisa Urita; Toko Shinkai; Hajime Takayasu; Shigemi Hitomi

doi:10.5223/pghn.2021.24.6.510

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자료유형: 학술저널

저자정보: Tsubasa Aiyoshi (University of Tsukuba) Kouji Masumoto (University of Tsukuba) Nao Tanaka (University of Tsukuba) Takato Sasaki (University of Tsukuba) Fumiko Chiba (University of Tsukuba) Kentaro Ono (University of Tsukuba) Takahiro Jimbo (University of Tsukuba) Yasuhisa Urita (University of Tsukuba) Toko Shinkai (University of Tsukuba) Hajime Takayasu (University of Tsukuba) Shigemi Hitomi (University of Tsukuba)

저널정보: 대한소아소화기영양학회 Pediatric Gastroenterology, Hepatology & Nutrition Pediatric Gastroenterology, Hepatology & Nutrition 제24권 제6호

발행연도: 2021.11

수록면: 510 - 517 (8page)

DOI: 10.5223/pghn.2021.24.6.510

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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.

#Antibiotics #Complicated appendicitis #Culture #Pediatric #Peritoneal fluid

참고문헌 (30)

참고문헌 신청

Hadley GP / 2014 / Intra-abdominal sepsis--epidemiology, aetiology and management / Semin Pediatr Surg 23:357~362

Jimbo T / 2017 / Outcome of early discharge protocol after appendectomy for pediatric acute appendicitis / Pediatr Int 59:803~806

Centers for Disease Control and Prevention (CDC) / Surgical site infection (SSI) event: procedure-associated module

David IB / 1982 / Rational use of antibiotics for perforated appendicitis in childhood / J Pediatr Surg 17:494~500

Elmore JR / 1987 / The treatment of complicated appendicitis in children. What is the gold standard? / Arch Surg 122:424~427

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