Evaluation of microbiota in children with acute appendicitis

Treatment strategies for acute uncomplicated appendicitis has evolved that conservative antibacterial treatment is now recommended  over surgical treatment, especially in pediatric patients. The aim of this research was to evaluate microbiota in pediatric patients surgically treated with acute uncomplicated and complicated appendicitis, and antibacterial susceptibility of the causative microorganisms. This prospective cohort study included children with suspected AA (7-17 year age). Bacteriological examination was performed on swab samples from the distal and proximal ends of the appendiceal lumen, submucosa of the appendix, and peritoneal cavity. Bacteriological identification was realized using the VITEK2 analyser. Antibacterial susceptibility tests were performed in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Serodiagnosis of Yersenia enterocolitica was performed using indirect haemagglutination. Microsoft Excel 2016 and IBM SPSS Statistics 22 were used for statistical analysis. This study was performed in accordance with the ethical standards of the institutional committee. The results revealed differences in microbiota in cases of acute complicated and acute uncomplicated appendicitis. Pseudomonas aeruginosa was identified more frequently in cases of acute complicated appendicitis. Mixed culutre was prevalent in cases of acute complicated and acute uncomplicated appendicitis. Only a couple positive extended spectrum beta-lactamase ( ESBL ) E. Coli cultures were identified.Most of the strains of Pseudomonas aeruginosa were resitant to amoxicillin and clavulanic acid, ertapenem, ampicillin and cefotaxime. E. Coli isolates were resistent to ampicillin and to amoxicillin with clavulanic acid. In cases of acute complicated appendicitis, P. aeruginosa is the prevalent microorganism, whereas E. Coli is the most commonly isolated microorganism in acute uncomplicated appendicitis. Treatment strategies for AA should include antibiotics with different mechanisms of action to achieve a synergistic effect and prevent the development of antibiotic resistance. Guidelines for empiric antibiotic therapy should be reviewed periodically to ensure compliance with current antibacterial susceptibility patterns.