The effect of antibiotic therapy and postoperative complications of the result of peritoneal liquid culture and antibiogram taken during the surgery in children with perforated appendicitis

Perforated appendicitis in children is the most common cause of community-acquired intra-abdominal infection (CA-IAI). Intra-abdominal infections continue to cause morbidity and mortality despite advances in the treatment. Excessive use of antimicrobial agents leads to the development of microbial resistance and loss of the effect of anti-infective agents. There are no studies on the prevalence of microorganisms and the susceptibility of these pathogens to various antibiotics in community-acquired CA-IAI in children in our region. There are a limited number of studies on this subject in children in our country and in the world. In this study, we aimed to define the prevalence of isolated microorganisms and the susceptibility of these agents to antibiotics, the effectiveness of antibiotic protocols and to reveal their effects on postoperative complications by retrospectively evaluating the intra-abdominal fluid culture and antibiogram results obtained during the operation in children who were operated for perforated appendicitis at the Ministry of Health Adıyaman University Training and Research Hospital Pediatric Surgery Clinic between 2014 and 2020. 167 strains were isolated in the intra-abdominal fluid cultures of 154 patients. Isolated microorganisms were E.coli 132 (79%), P.aeruginosa 23 (13.8%), K. pneumonia 4 (2.4%), Enterecoccus raffinnosus 4 (2.4%), Enterobacter cleocae 3 (1%) .8) and Staffilococcus hominis 1 (0.6%). The susceptibility of isolated E.coli to ampicillin/sulbactam, ceftriaxone, cefotaxime and amikacin, which we use in empirical treatment in our clinic, was 25%, 59%, 98%, and 99%, respectively, and P. aeruginosa's susceptibility to ampicillin/sulbactam, ceftriaxone, cefotaxime and amikacin, was 8%, 16%, 0% ve 99% respectively. Susceptibility of K.pneumonia to ampicillin/sulbactam, ceftriaxone, cefotaxime and amikacin was 0.7%, 75% ,100%, respectively, E. raffinosus susceptibility to ampicillin/sulbactam, ceftriaxone, cefotaxime and amikacin were found as 0%, 33%, 100%, and 100%, respectively. Empirical antibiotic therapy started before surgery in 102 of 154 cases was changed after surgery. After the operation, 20.1% (31) of the patients developed intra-abdominal abscess and 25.3% (39) wound site infection developed. In this study; In Adıyaman province, the bacteria isolated from perforated appendicitis in children are E.Coli, P.Aeroginosa, K.pneuonia and E.cleocea, in order of frequency. It was determined that abscess and wound infection developed, antibiotic revision was made in more than half of the patients and the hospitalization period was prolonged, and after the antibiotic revision, all of the abscess cases were healed with antibiotic treatment, except for one. We think that the establishment of appropriate empirical antibiotic protocols with studies on the prevalence of microorganisms and the susceptibility of these pathogens to various antibiotics in community-acquired CA-IAI due to perforated appendicitis in children may reduce the length of hospitalization, postoperative complications, and treatment costs. Keywords: Intra-abdominal infection, perforated appendicitis, children, empirical antibiotic therapy, intra-abdominal fluid culture, antibiotic sensitivity