Bacteriology, Antibiotic Susceptibility and Empirical Antibiotics of Community-acquired Perforated Appendicitis

Hyeong Uk Ju; Hyun Seong Lee; Jae Hee Kim; Jae Wan Jeon; Gyu Yeol Kim; Joseph Jeong; Jae-Bum Jun

doi:10.3947/ic.2012.44.6.439

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Ju, Lee, Kim, Jeon, Kim, Jeong, and Jun: Bacteriology, Antibiotic Susceptibility and Empirical Antibiotics of Community-acquired Perforated Appendicitis

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2012; 44(6): 439-445.

Published online: 31 December 2012

DOI: https://doi.org/10.3947/ic.2012.44.6.439

Bacteriology, Antibiotic Susceptibility and Empirical Antibiotics of Community-acquired Perforated Appendicitis

Hyeong Uk Ju¹, Hyun Seong Lee¹, Jae Hee Kim¹, Jae Wan Jeon¹, Gyu Yeol Kim², Joseph Jeong³, Jae-Bum Jun¹

¹Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

²Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

³Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Correspondence to Jae-Bum Jun, M.D. Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Korea. Tel: +82-52-250-8930, Fax: +82-52-250-8858, uvgotletter@hanmail.net

Received 10 September 2012 Revised 26 October 2012 Accepted 26 October 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The aim of this study was to study bacteriology and antibiotic susceptibility in patients with community-acquired perforated appendicitis over a five-year-period.

Materials and Methods

We conducted a retrospective review of the records of adult patients (age ≥18 years) who were diagnosed as having perforated appendicitis at Ulsan University Hospital between January 2007 and December 2011. Patients who had healthcare-associated or hospital-acquired appendicitis were excluded. Intraoperative specimens submitted to the microbiology laboratory were obtained either by aspiration of pus into a syringe or by use of a swab. Anaerobic bacterial cultures were not performed.

Results

Among 216 adult patients with perforated appendicitis, we analyzed 163 culture-positive cases. The overall mortality rate of patients was 0.6% (1/163). Escherichia coli was the most common pathogen (93/163, 57.0%), followed by Streptococcus spp. (45/163, 27.6%), Pseudomonas aeroginosa (13/163, 7.9%), and Enterococcus spp. (17/163, 10.4%). The susceptibility of E. coli to quinolones (ciprofloxacin or levofloxacin) was 74.1%. The susceptibility of E. coli to amoxicillin/clavulanate, cefoxitin, ceftriaxone, piperacillin/tazobactam, and carbapenem reached 75%, 86%, 90%, 98%, and 100%, respectively. Isolated E. coli, including ESBL producing organism and P. aeroginosa, were highly susceptible to piperacillin/tazobactam. Empirical antibiotics used most commonly were a combination of third generation cephalosporin and metronidazole.

Conclusion

E. coli was the most common pathogen of community-acquired perforated appendicitis, and resistance to quinolone was greater than 25%. We cannot recommend quinolones for use as empirical therapy for treatment of perforated appendicitis.

Keywords: Escherichia coli, Appendicitis, Quinolones

Figures and Tables

Table 1

Baseline Characteristics of Patients with Perforated Appendicitis

Table 2

Distribution of bacterial species

^aKlebsiella spp.: Klebsiella oxytica, Klebsiella pneumonia

^bOther gram negative organism: Achromobacter xylosoxidans, Comamonas testoteroni, Hafnia alvei, Raultella planticola, Aeromonas hydrophilia, Proteus mirabilis, Acinetobacter lwoffii, Serratia spp., Enterobacter cloacae

^cStreptococcus spp.: S. viridans, S. constellatus, S. cristatus, S. gordonii, S. intermedius, S. mitis, S. salivarius, S. sanguinis, S. anginosus, S. alactolyticus

^dEnterococcus spp.: E. avium, E. faecium, E. gallinarum, E. faecalis, E. hirae, E. raffinosus

^eBacillus spp.: Bacillus cereus, Bacillus megaterium, Bacillus amyloliquefaciens

^fOther gram positive organisms: Lactococcus garvieae, Leuconostoc mesenteroides, Pedicoccus pentosaceus, Gemella morbillorum

Table 3

Antibiotic Susceptibilities of Isolated Organisms that Caused Perforated Appendicitis

AMX/CL, amoxicillin/clavulanate; CFTRX or CFTM, ceftriaxone or cefotaxime; CFOX, cefoxitin; CFPM, cefepime; TMP/SMX, trimethoprim/sulfamethoxazole; PC, penicillin; CFX or LFX, ciprofloxacin or levofloxacin; PIPC/TB, piperacillin/tazobactam; AMK, amikacin; TBM, tobramycin

^aFirst CEP: First generation cephalosporin-sensitivity test not performed

Table 4

Comparisons of Bacterial Species and Antibiotic Susceptibilities of E. coli between the Sepsis Group and the Severe Sepsis Group

^aThe difference between two groups was statistically significant (P<0.05).

Table 5

Inappropriate Empirical Treatment for Patients with Perforated Appendicitis

Antibiotic susceptibility results of Enterococcus spp. and other gram positive cocci were not included in this analysis.

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