Community-acquired complicated intra-abdominal infections in children hospitalized during 1995–2004 at a paediatric surgery department

• Published in: Scandinavian journal of infectious diseases 2009, Vol.41 (10), p.720-726
• Main Authors: Newman, Nitza, Wattad, Eman, Greenberg, David, Peled, Nehama, Cohen, Zahavi, Leibovitz, Eugene
• Format: Article
• Language: English
• Subjects: Abdominal Abscess - drug therapy; Abdominal Abscess - epidemiology; Abdominal Abscess - microbiology; Adolescent; Anti-Bacterial Agents - therapeutic use; Appendicitis - drug therapy; Appendicitis - epidemiology; Appendicitis - microbiology; Biological and medical sciences; Child; Child, Preschool; Community-Acquired Infections - drug therapy; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Escherichia coli - isolation & purification; Escherichia coli Infections - drug therapy; Escherichia coli Infections - epidemiology; Female; Humans; Infant; Infectious diseases; Male; Medical sciences; Peritonitis - drug therapy; Peritonitis - epidemiology; Peritonitis - microbiology; Retrospective Studies; Surgery Department, Hospital - statistics & numerical data
• ISSN: 0036-5548; 1651-1980
• DOI: 10.1080/00365540903159261

Information on the epidemiologic, clinical, microbiologic and therapeutic aspects of community-acquired complicated intra-abdominal infections in paediatrics is limited. The objectives of this study were to investigate the epidemiologic, clinical, microbiologic and therapeutic characteristics of community-acquired complicated intra-abdominal infections occurring in children aged 1 month–15 y. Medical charts and microbiology data of all children hospitalized with complicated intra-abdominal infections were retrospectively examined. Complicated intra-abdominal infections were defined as infections extending beyond the viscus of origin into the peritoneal space, with subsequent development of abscess or peritonitis. One hundred and twenty-three patients with complicated intra-abdominal infections (99/123, 80% >5 y of age) were included; 113 (92%) had complicated acute appendicitis. Twelve (10%) patients underwent computerized tomography-guided percutaneous drainage of periappendicular abscesses. The mean rate of complicated intra-abdominal infections among patients with complicated acute appendicitis was 10% without significant changes during the study years. Positive intra-abdominal cultures were recorded in 97/108 (90%) evaluable patients; 65/97 (67%) cases were characterized by mixed bacterial flora growth. One hundred and ninety pathogens (aerobes n=164, 86%; anaerobes n=26, 14%) were isolated. Escherichia coli was the most common pathogen (94 isolates, 57%). In vitro amoxicillin/clavulanate coverage of E. coli and Klebsiella spp was modest (81% and 86%, respectively). The ampicillin/gentamicin/metronidazole regimen was more appropriate in vitro than the amoxicillin/clavulanate regimen (3/80, 4% resistant pathogens compared with 8/43, 19%; p=0.02). Post-operative complications were recorded in 33/123 (27%) patients. Time until defervescence to < 37.5°C was shorter in children with periappendicular abscess than in children with generalized peritonitis (6±4 vs 4±3 days; p=0.009). In conclusion: (1) most community-acquired complicated intra-abdominal infections occurred as a result of acute appendicitis; (2) the rate of complicated intra-abdominal infections among patients with acute appendicitis was low and without significant changes during the study period; (3) E. coli was the most frequently isolated pathogen; (4) amoxicillin/clavulanate provided only partial coverage for complicated intra-abdominal infection pathogens and should be used with caution in