title: Bacterial studies of complicated appendicitis over a 20-year period and their impact on empirical antibiotic treatment.
abstract: BACKGROUND
  Multiresistant bacterial strains tend to develop, especially enterobacteriacae, in intraabdominal infections. The aim of this study was to characterize the evolution of the bacterial biota in complicated appendicitis in children over the past 20 years and their acquired resistance rates to antibiotics.
  
  
  METHODS
  All pediatric patients admitted in the emergency unit for complicated appendicitis were retrospectively reviewed during 3 periods: 1989 to 1991, 1999 to 2000, and 2009 to 2010. Results of peritoneal swabs were analyzed regarding bacterial species and resistance to antibiotics. Statistical significance was set at P < .05.
  
  
  RESULTS
  Thirty-four, 48, and 85 patients from the 3 periods, respectively, were included, with 1 to 6 bacterial strains found in each peritoneal sample. During the first period, 80% of the biota was composed of enterobacteriacae and anaerobes and then decreased to 65%, whereas streptococci levels increased from 0 to 22%. Pansusceptibility rates remained stable (17%, 16.8%, and 15.6% for the 3 periods, respectively). Piperacillin, vancomycin, ticarcillin-clavulanic acid, and fluoroquinolones were associated with increased resistance rates, unlike antibiotic associations currently used as postoperative treatments.
  
  
  CONCLUSIONS
  No significant increase in resistance rates of bacteriacae in complicated appendicitis in children was found over the last 20 years. Empirical antibiotherapy protocols currently recommended remain efficient on this particular biota.
authors.affiliation: Department of Pediatric Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France. francoise.schmitt1@free.fr
authors.forename: Françoise
authors.initials: F
authors.lastname: Schmitt
authors.forename: Pauline
authors.initials: P
authors.lastname: Clermidi
authors.forename: Marine
authors.initials: M
authors.lastname: Dorsi
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cocquerelle
authors.forename: Cindy Ferreira
authors.initials: CF
authors.lastname: Gomes
authors.forename: François
authors.initials: F
authors.lastname: Becmeur
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001062:Appendectomy; D001064:Appendicitis / Q000188:drug therapy / Q000191:economics / Q000382:microbiology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D052978:Disk Diffusion Antimicrobial Tests; D024881:Drug Resistance, Bacterial; D005260:Female; D005602:France; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000191:economics / Q000382:microbiology* / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000191:economics / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D008297:Male; D010537:Peritoneum / Q000382:microbiology; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents