IMAJ | volume 26
Journal 6, June 2024
pages: 355-360
1 Pediatric Infectious Diseases Unit, Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
2 Department of Pediatric Surgery, Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
3 Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
4 Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel
5 Department of Family Medicine, Maccabi Healthcare Services, Hod HaSharon, Israel
6 Department of Pediatrics, Ziv Medical Center, Safed, Israel
7 Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
Summary
Background:
Pseudomonas aeruginosa (PSA) is an infectious pathogen associated with acute appendicitis; however, it is not consistently addressed by empirical antibiotic therapy, despite potential complications.
Objectives:
To investigate the incidence, predictors, and outcomes of PSA-associated acute appendicitis in children.
Methods:
We conducted a retrospective analysis involving pediatric patients who underwent acute appendicitis surgery and had positive peritoneal cultures. Clinical, microbiological, and intraoperative data were extracted from medical records.
Results:
Among 2523 children with acute appendicitis, 798 (31.6%) underwent peritoneal cultures, revealing 338 positive cases (42.3%), with PSA detected in 77 cases (22.8%). Children with PSA were three times more likely to exhibit high intraoperative grading ≥ 3 (93.4% vs. 76.8%, 95% confidence interval [95%CI] 1.2–8.3,
P = 0.023) and nearly four times more likely to have polymicrobial cultures (88.3% vs. 62.1%, 95%CI 1.8–8.0,
P < 0.001) than those without PSA in peritoneal cultures. Duration of symptoms did not predict PSA isolation (
P = 0.827). Patients with PSA had longer median hospital stays (8 days, interquartile range [IQR] 7–10) than those with other pathogens (7 days, IQR 5–9) (
P = 0.004). Antibiotic treatment duration, intensive care unit admission rates, readmission, and mortality were similar between the two groups (
P = 0.893, 0.197, 0.760, and 0.761, respectively).
Conclusions:
PSA is a common pathogen in children diagnosed with acute appendicitis and positive peritoneal cultures. The likelihood of isolating PSA increases with high-grade intraoperative assessment and in the presence of multiple pathogens in peritoneal cultures, suggests antipseudomonal treatment.