Microbiota Assessment of Pediatric Simple and Complex Acute Appendicitis

Mohit Kakar (Coresponding Author), Aigars Reinis, Juta Kroiča, Arnis Eņģelis, Renārs Broks, Lāsma Asare, Marelize Vermeulen, Simone Oliver Senica, Amulya Saxena, Aigars Pētersons

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
14 Downloads (Pure)


Background and Objectives. The aim of this study is to determine the prevailing microbiota in samples from pediatric patients with acute appendicitis, as well as evaluate the antibacterial sensitivity of the isolated microorganisms, comparing the data obtained with the clinic's antibacterial therapy guidelines. Materials and Methods. The study group consisted of 93 patients between the ages of 7 and 18. All patients underwent a laparoscopic or conventional appendectomy. The children were hospitalized with signs and symptoms suggestive of acute appendicitis. Microbiological cultures from the appendix and abdominal cavity were collected intraoperatively. Results. E. coli was identified in most cases irrespective of the clinical presentation of acute appendicitis. Most strains were susceptible to ampicillin and amoxicillin/clavulanic acid. Five strains of E. coli produced extended spectrum beta-lactamase (ESBL). Pseudomonas aeruginosa (P. aeruginosa) was the second most commonly isolated causative agent. Furthermore, it was common in cases of acute complex appendicitis. Most strains of P. aeruginosa were resistant to amoxicillin/clavulanic acid, ertapenem, ampicillin and cefotaxime, yet were susceptible to ceftazidime. Regardless of the clinical presentation, the samples yielded mixed isolates. Conclusion. E. coli is the main causative agent of acute appendicitis in the pediatric population displaying susceptibility to various antibiotics. P. aeruginosa was more prevalent in cases of acute complex appendicitis. P. aeruginosa isolates were susceptible to ceftazidime; however, they were resistant to cefotaxime, which should, therefore, be removed from guidelines for empirical antibacterial treatment of acute appendicitis due to phenotypic resistance of P. aeruginosa. We recommend antibiotics with distinct implementation to avoid antibiotic resistance.

Original languageEnglish
Article number1144
Pages (from-to)1144
Number of pages10
JournalMedicina (Kaunas, Lithuania)
Issue number9
Publication statusPublished - Sept 2022


  • Adolescent
  • Amoxicillin-Potassium Clavulanate Combination/pharmacology
  • Anti-Bacterial Agents/pharmacology
  • Appendicitis/surgery
  • Cefotaxime/therapeutic use
  • Ceftazidime/therapeutic use
  • Child
  • Ertapenem/therapeutic use
  • Escherichia coli
  • Humans
  • Microbiota
  • Pseudomonas aeruginosa
  • beta-Lactamases/therapeutic use

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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