Tugay TARTAR, Ayşe SAĞMAK TARTAR, Mehmet SARAÇ, Ünal BAKAL, Ayhan AKBULUT, Ahmet KAZEZ

Does microbial resistance profile change in community-based intra-abdominal infections? Evaluation of the culture results of patients with appendicitis

Most common origin of intra-abdominal infections in children is appendicitis.Microorganisms responsible for community-based and hospital-acquired intraabdominal infections vary. The aim of this study was to evaluate microbialculture outcomes and antibiotic susceptibilities of these microorganisms insamples obtained intraoperatively from pediatric patients with appendicitis, andto define the infectious microorganisms responsible for the community-basedintra-abdominal infections in our region, and their antibiotic susceptibilities.This study included 231 patients between 0 and 16 years of age, operatedon due to appendicitis between 2014 and 2017. Appendicular tissues weresampled intraoperatively. Antibiogram was studied in case of reproductionin tissue culture. Forms included information on the age and gender of thepatients, intra-abdominal event, bacterial growth in microbial culture andantibiogram, antibiotic switch during follow-up, duration of the treatment,complications and outcomes were recorded. No microbial growth was observedfollowing inoculation of the samples obtained from appendiceal tissue of24.7% patients, whereas growth was positive in 75.3%. Gram negative bacteriawere isolated in 94.3% of the patients, whereas gram positive bacteria wasisolated in 5.7%. Polymicrobial growth was observed in 2.2% of the patients.E. coli in 79.9%, P. aeruginosa in 5.2%, Enterobacter cloacae in 3.4%, Coagulasenegative staphylococci in 3.4%, Klebsiella spp. in 1.7%, Citrobacter spp. in 1.7%,Enterococcus spp. in 1.7%, Comamonas testosteroni in 1.2% of patients produced.ESBL positivity is present in 51 (36.7%) of 139 E. coli strains reproducingin appendiceal tissue culture. ESBL was positivity detected in one of thereproduced 3 Klebsiella spp. strains. In E. coli, ciprofloxacin resistance as 20.86%,ampicillin-sulbactam resistance as 83.45%, and co-trimoxazole resistance as41% were found. Our study clearly demonstrates that the resistance profilevaries in community-based intra-abdominal infections. Empirical treatmentprotocols should be revised in especially the patients admitted with septicpresentation and where the source control is not possible.

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