title: Failure of First-Line Antibiotics in Nonoperative Management of Appendiceal Mass, toward a Second-Line Instead of Surgery?
abstract: Background Conservative approach for complicated appendicitis has been gradually adopted in children to decrease postoperative morbidity. The first aim of this study was to assess the efficacy of a second-line antibiotics enlarged on Pseudomonas aeruginosa and Enterococcus in case of poor clinical outcome after initial conservative approach for appendiceal mass and abscess. The second aim of this study was to identify predictive factors of failure of first-line antibiotics. Methods We performed a prospective review of all the cases of appendiceal mass or abscess managed at our institution between November 2007 and September 2011 after implementation of a conservative protocol including a second-line antibiotics in case of poor initial clinical outcome. Results A total of 64 consecutive patients were included. We observed a success in 46 patients after the first-line antibiotics and in 14 of the remaining patients after the second-line. The only predictive factor of failure of the first-line antibiotics was a shorter duration of symptoms before admission (p = 0.02). Laparoscopic appendectomy was performed in all the cases (emergency or interval procedure) with six postoperative complications and two conversions to open surgery. Conclusions A gradual adapted antibiotherapy in nonoperative management of appendiceal abscess and mass is effective. We found no relevant predictive factor of failure of the first-line antibiotics.
authors.affiliation: General Pediatric Surgery, Robert Debré Children University Hospital, Paris, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Parmentier
authors.affiliation: Department of Pediatric Pathology, Robert Debré Children University Hospital, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Berrebi
authors.affiliation: General Pediatric Surgery, Robert Debré Children University Hospital, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Peycelon
authors.affiliation: Department of Microbiology, Robert Debré Children University Hospital, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Doit
authors.affiliation: General Pediatric Surgery, Robert Debré Children University Hospital, Paris, France.
authors.forename: Alaa El
authors.initials: AE
authors.lastname: Ghoneimi
authors.affiliation: General Pediatric Surgery, Robert Debré Children University Hospital, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bonnard
mesh_terms: D000038:Abscess / Q000188:drug therapy* / Q000382:microbiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy; D001064:Appendicitis / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D000072700:Conservative Treatment / Q000379:methods*; D016983:Enterococcus; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents