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Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study

BACKGROUND: Appendicitis is a frequent condition, with peak incidences in the second decade of life. Its pathogenesis is under debate, but bacterial infections are crucial, and antibiotic treatment remains essential. Rare bacteria are accused of causing complications, and various calculated antibiot...

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Autores principales: Felber, Julia, Gross, Benedikt, Rahrisch, Arend, Waltersbacher, Eric, Trips, Evelyn, Schröttner, Percy, Fitze, Guido, Schultz, Jurek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10205019/
https://www.ncbi.nlm.nih.gov/pubmed/37228669
http://dx.doi.org/10.3389/fcimb.2023.1027769
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author Felber, Julia
Gross, Benedikt
Rahrisch, Arend
Waltersbacher, Eric
Trips, Evelyn
Schröttner, Percy
Fitze, Guido
Schultz, Jurek
author_facet Felber, Julia
Gross, Benedikt
Rahrisch, Arend
Waltersbacher, Eric
Trips, Evelyn
Schröttner, Percy
Fitze, Guido
Schultz, Jurek
author_sort Felber, Julia
collection PubMed
description BACKGROUND: Appendicitis is a frequent condition, with peak incidences in the second decade of life. Its pathogenesis is under debate, but bacterial infections are crucial, and antibiotic treatment remains essential. Rare bacteria are accused of causing complications, and various calculated antibiotics are propagated, yet there is no comprehensive microbiological analysis of pediatric appendicitis. Here we review different pre-analytic pathways, identify rare and common bacterial pathogens and their antibiotic resistances, correlate clinical courses, and evaluate standard calculated antibiotics in a large pediatric cohort. METHOD: We reviewed 579 patient records and microbiological results of intraoperative swabs in standard Amies agar media or fluid samples after appendectomies for appendicitis between May 2011 and April 2019. Bacteria were cultured and identified via VITEK 2 or MALDI-TOF MS. Minimal inhibitory concentrations were reevaluated according to EUCAST 2022. Results were correlated to clinical courses. RESULTS: Of 579 analyzed patients, in 372 patients we got 1330 bacterial growths with resistograms. 1259 times, bacteria could be identified to species level. 102 different bacteria could be cultivated. 49% of catarrhal and 52% of phlegmonous appendices resulted in bacterial growth. In gangrenous appendicitis, only 38% remained sterile, while this number reduced to 4% after perforation. Many fluid samples remained sterile even when unsterile swabs had been taken simultaneously. 40 common enteral genera were responsible for 76.5% of bacterial identifications in 96.8% of patients. However, 69 rare bacteria were found in 187 patients without specifically elevated risk for complications. CONCLUSION: Amies agar gel swabs performed superior to fluid samples and should be a standard in appendectomies. Even catarrhal appendices were only sterile in 51%, which is interesting in view of a possible viral cause. According to our resistograms, the best in vitro antibiotic was imipenem with 88.4% susceptible strains, followed by piperacillin-tazobactam, cefuroxime with metronidazole, and ampicillin-sulbactam to which only 21.6% of bacteria were susceptible. Bacterial growths and higher resistances correlate to an elevated risk of complications. Rare bacteria are found in many patients, but there is no specific consequence regarding antibiotic susceptibility, clinical course, or complications. Prospective, comprehensive studies are needed to further elicit pediatric appendicitis microbiology and antibiotic treatment.
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spelling pubmed-102050192023-05-24 Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study Felber, Julia Gross, Benedikt Rahrisch, Arend Waltersbacher, Eric Trips, Evelyn Schröttner, Percy Fitze, Guido Schultz, Jurek Front Cell Infect Microbiol Cellular and Infection Microbiology BACKGROUND: Appendicitis is a frequent condition, with peak incidences in the second decade of life. Its pathogenesis is under debate, but bacterial infections are crucial, and antibiotic treatment remains essential. Rare bacteria are accused of causing complications, and various calculated antibiotics are propagated, yet there is no comprehensive microbiological analysis of pediatric appendicitis. Here we review different pre-analytic pathways, identify rare and common bacterial pathogens and their antibiotic resistances, correlate clinical courses, and evaluate standard calculated antibiotics in a large pediatric cohort. METHOD: We reviewed 579 patient records and microbiological results of intraoperative swabs in standard Amies agar media or fluid samples after appendectomies for appendicitis between May 2011 and April 2019. Bacteria were cultured and identified via VITEK 2 or MALDI-TOF MS. Minimal inhibitory concentrations were reevaluated according to EUCAST 2022. Results were correlated to clinical courses. RESULTS: Of 579 analyzed patients, in 372 patients we got 1330 bacterial growths with resistograms. 1259 times, bacteria could be identified to species level. 102 different bacteria could be cultivated. 49% of catarrhal and 52% of phlegmonous appendices resulted in bacterial growth. In gangrenous appendicitis, only 38% remained sterile, while this number reduced to 4% after perforation. Many fluid samples remained sterile even when unsterile swabs had been taken simultaneously. 40 common enteral genera were responsible for 76.5% of bacterial identifications in 96.8% of patients. However, 69 rare bacteria were found in 187 patients without specifically elevated risk for complications. CONCLUSION: Amies agar gel swabs performed superior to fluid samples and should be a standard in appendectomies. Even catarrhal appendices were only sterile in 51%, which is interesting in view of a possible viral cause. According to our resistograms, the best in vitro antibiotic was imipenem with 88.4% susceptible strains, followed by piperacillin-tazobactam, cefuroxime with metronidazole, and ampicillin-sulbactam to which only 21.6% of bacteria were susceptible. Bacterial growths and higher resistances correlate to an elevated risk of complications. Rare bacteria are found in many patients, but there is no specific consequence regarding antibiotic susceptibility, clinical course, or complications. Prospective, comprehensive studies are needed to further elicit pediatric appendicitis microbiology and antibiotic treatment. Frontiers Media S.A. 2023-05-09 /pmc/articles/PMC10205019/ /pubmed/37228669 http://dx.doi.org/10.3389/fcimb.2023.1027769 Text en Copyright © 2023 Felber, Gross, Rahrisch, Waltersbacher, Trips, Schröttner, Fitze and Schultz https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cellular and Infection Microbiology
Felber, Julia
Gross, Benedikt
Rahrisch, Arend
Waltersbacher, Eric
Trips, Evelyn
Schröttner, Percy
Fitze, Guido
Schultz, Jurek
Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study
title Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study
title_full Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study
title_fullStr Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study
title_full_unstemmed Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study
title_short Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study
title_sort bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study
topic Cellular and Infection Microbiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10205019/
https://www.ncbi.nlm.nih.gov/pubmed/37228669
http://dx.doi.org/10.3389/fcimb.2023.1027769
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