Appendectomy in pediatrics : the value of peritoneal Fluid Smear and its bacteriological Profile

Abstract

Acute appendicitis is the most common cause of abdominal pain requiring surgery in children. In most instances the infecting organisms are normal inhabitants of the lumen of appendix . Surgery allows easy microbiological sampling. Aspiration of fluid or pus in a syringe is preferred. Swabs are less suitable and only to be used when sampling with a syringe is not feasible. Antimicrobial susceptibility testing of the isolated bacteria and particularly of the anaerobes can be important to adjust therapy in case of the presence of multi resistant bacteria. The aim of the study was to determine the bacteriological profile of acute appendicitis in children. Study design is a prospective descriptive study including children hospitalized for acute appendicitis. Tissue samples(a specimen of the appendix), peritoneal fluid swab from the appendicial fossa and the peritoneal exudates (if exists) obtained at surgery from 54 children with suspected acute appendicitis operated at the pediatric surgery unit at the Maternity and Child Teaching Hospital in Al- Diwaniyah province from the period 1st of June 2007 to the end of May 2011, were examined histologically and by culture for aerobic and anaerobic bacteria. Out of these, 39 boys (72.2%) and 15 ( 27.7% girls). Their age ranged between (1.8-13) years, with a mean of 6.9 years. Of the all patients studied 34 presented with suppurative and phlegmnous appendicitis, 8 with gangrenous appendicitis, 6 with septic complications of appendicitis and 6 had normal appendices. Only 80 of the 108 swabs taken yielded a positive culture (74.07%). Bacteroides species and E.coli were the predominant organisms in most normal and acutely inflamed appendices. Aerobic bacteria were highly sensible to imipenem, amikacin, ceftriaxone and clindamicyn, but it was absolutely resistance to ampicillin. For anaerobic bacteria, sensitivity rates from high to low were chloramphenicol, carbenicillin, metronidazole and clindamycin. Although in our study no antibiotic regime was changed on the basis of a positive culture swab and the peritoneal culture swabs do not improve immediate postoperative therapy based on surgical impression and rapid histological reporting, however, the routine use of peritoneal culture swabs may be of value in identifying patients requiring outpatient follow-up.