title: Susceptibility to antibiotics of aerobic bacteria isolated from community acquired secondary peritonitis in children: therapeutic guidelines might not always fit with and everyday experience.
abstract: Appendicitis is a frequent clinical condition in normal children that may be complicated by community-acquired secondary peritonitis (CASP). We evaluated the potential efficacy of different drugs for initial treatment of this condition, as recommended by recent Consensus Conference and Guidelines for paediatric patients. Susceptibility to ampicillin-sulbactam, ertapenem, gentamycin, piperacillin, piperacillin-tazobactam, vancomycin, and teicoplanin was evaluated according to EUCST 2012 recommendations in aerobic bacteria isolated from peritoneal fluid in CASP diagnosed from 2005 to 2011 at 'Istituto Giannina Gaslini', Genoa, Italy. A total of 114 strains were analysed: 83 E. coli, 15 P. aeruginosa, 6 Enterococci, and 10 other Gram-negatives. Resistance to ampicillin-sulbactam was detected in 37% of strains, while ertapenem showed a potential resistance of 13% (all P. aeruginosa strains). However, the combination of these drugs with gentamicin would have been increased the efficacy of the treatment to 99 and 100%, respectively. Resistance to piperacillin-tazobactam was 3%, while no strain was resistant to meropenem. Our data suggest that monotherapy with ampicillin-sulbactam or ertapenem for community-acquired secondary peritonitis would present a non-negligible rate of failure, but the addition of gentamycin to these drugs could reset to zero this risk. On the contrary, monotherapy with piperacillin-tazobactam or meropenem is highly effective.
authors.affiliation: Infectious Diseases Unit, Hospital Infection Control Team. eliocastagnola@ospedale-gaslini.ge.it
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.forename: Roberto
authors.initials: R
authors.lastname: Bandettini
authors.forename: Francesca
authors.initials: F
authors.lastname: Ginocchio
authors.forename: Maddalena
authors.initials: M
authors.lastname: Perotti
authors.forename: Daniela La
authors.initials: DL
authors.lastname: Masa
authors.forename: Antonella
authors.initials: A
authors.lastname: Ciucci
authors.forename: Anna
authors.initials: A
authors.lastname: Loy
authors.forename: Ilaria
authors.initials: I
authors.lastname: Caviglia
authors.forename: Riccardo
authors.initials: R
authors.lastname: Haupt
authors.forename: Edoardo
authors.initials: E
authors.lastname: Guida
authors.forename: Alessio
authors.initials: A
authors.lastname: Pini Prato
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
authors.forename: Piero
authors.initials: P
authors.lastname: Buffa
mesh_terms: D000667:Ampicillin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D000077727:Ertapenem; D005839:Gentamicins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D006776:Hospitals, Pediatric; D006801:Humans; D007558:Italy / Q000453:epidemiology; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D010538:Peritonitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D010878:Piperacillin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D017410:Practice Guidelines as Topic; D013407:Sulbactam / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D013845:Thienamycins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D047090:beta-Lactams / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D013845:Thienamycins; D047090:beta-Lactams; D000077725:Piperacillin, Tazobactam Drug Combination; C035444:sultamicillin; D000667:Ampicillin; D010397:Penicillanic Acid; D000077731:Meropenem; D000077727:Ertapenem; D013407:Sulbactam; D010878:Piperacillin