Impact of Percutaneous Drainage on Outcome of Intra-abdominal Infection Associated with Pediatric Perforated Appendicitis

William Bonadio, Miriam Langer, Julie Cueva, Astrid Haaland

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Perforated appendicitis can result in potentially serious complications requiring prolonged medical care. The optimal approach to successfully managing this condition is controversial. Methods: Review of 80 consecutive cases of pediatric acute perforated appendicitis with intra-abdominal infection (IAI) medically managed with parenteral antibiotics and percutaneous drainage (PD) during a 7-year period. Results: All patients received broad spectrum parenteral antibiotic therapy. One-third were hospitalized for >2 weeks. IAI was identified on admission in 60% compared with developing during hospitalization in 40% of cases. Before performing PD, the mean duration of antibiotic therapy in those who developed IAI during hospitalization was 6 days. IAI cultures yielded 127 bacterial isolates; polymicrobial infection occurred in 65% of cases. Only 7% of aspirates were sterile. The most common pathogens were Escherichia coli (82%), of which 5 isolates exhibited extended-spectrum β-lactamase production, and streptococci (40%). At the time of PD, 60% were febrile (mean duration of in-hospital fever, 7.5 days); 67% defervesced within 24 hours after the procedure. Posthospitalization abdominal complications (recurrent IAI or appendicitis) occurred in one-third of patients. Conclusions: Children with perforated appendicitis and IAI often have a complicated and prolonged clinical course. Medical management consisting solely of parenteral antibiotic therapy is frequently ineffective in resolving IAI. Rapid clinical improvement commonly follows PD.

Original languageEnglish
Pages (from-to)952-955
Number of pages4
JournalPediatric Infectious Disease Journal
Volume36
Issue number10
DOIs
StatePublished - 1 Oct 2017
Externally publishedYes

Keywords

  • appendicitis
  • intra-abdominal abscess
  • perforation

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