Abstract
Bacterial peritonitis is a complication of acute appendicitis in healthy children. To provide adequate antimicrobial therapy, the causative pathogens should be identified. Anaerobic and aerobic bacterial cultures of peritoneal fluid and blood were obtained prospectively in 12 consecutive children undergoing laparotomy for suspected appendicitis.
The diagnosis of appendicitis was confirmed at surgery in all cases. The study group's mean age was 8.3 years (2-17); 7 were male. All blood cultures were sterile. Nine patients had an average of 3.6 organisms recovered from the peritoneal fluid; E. coli was recovered from 8/9 children. Pseudomonas aeruginosa, B. fragilis, and Bacteroides spp. were recovered from 5 patients each; Peptococcus spp. was isolated from 4.
The recovery of Pseudomonas aeruginosa from the peritoneal fluid of 5 otherwise healthy children was surprising. The routine use of clindamycin and gentamicin in combination or third generation cephalosporins as single agents for the initial treatment of childhood peritonitis does not provide adequate activity against this organism. Although the frequency of recovery of Pseudomonas aeruginosa from peritoneal fluid may vary, we strongly suggest that children with appendicitis have bacterial cultures obtained and have antimicrobial therapy individualized.
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Aronoff, S., Olsen, M., Gauderer, M. et al. 1058 THE BACTERIOLOGY OF PERITONITIS IN CHILDREN WITH APPENDICITIS. Pediatr Res 19, 287 (1985). https://doi.org/10.1203/00006450-198504000-01088
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DOI: https://doi.org/10.1203/00006450-198504000-01088