title: Antibiotic resistance evaluation and clinical analysis of acute appendicitis; report of 1431 consecutive worldwide patients: A cohort study.
abstract: BACKGROUND
  Acute appendicitis (AA) is one of the most common diseases affecting especially young but also older people. A systematic evaluation of bacteriology of AA has been frequently conducted in children but is not well known and discussed in adult population.
  
  
  METHODS
  The study has been obtained from two multicenter prospective observational studies (CIAO and CIAOW studies). The aim of the study is to analyze the intra-abdominal bacteriology in AA and its relation with clinical outcomes.
  
  
  RESULTS
  Patients included were 1431, 806 male (56.3%). The mean/median age was 38.9 (SD ± 18.4) and 35 (range 18-94). Clinical condition at the admission was sepsis in 623 patients (43.5%), severe sepsis and septic shock in 29 (2%) and 10 (0.7%). Peritonitis was localized in 1107 patients (77.4%) and generalized in 324 (22.6%). Adequate source-control and empirical antimicrobial therapy were reported in 95.2% and 88.7% of the patients. 47 isolated bacteria (6.8%) were resistant. Two (4.2%) were health-care-associated infections and 45 (95.7%) were community-acquired infections. Univariate analysis showed factor associated to resistant bacteria was the inadequacy of the empiric antimicrobial therapy (p = 0.013); at multivariated analysis factors associated with mortality were age>70 years (p = 0.003) and severe sepsis at the admission (p = 0.02); factors associated to ICU admission were: severe sepsis (p < 0.0001), generalized peritonitis (p < 0.0001), malignancy (p < 0.0001) and cardiovascular disease (p < 0.0001).
  
  
  CONCLUSIONS
  The evolution of antimicrobial resistance, in common community-acquired infections, combined with lack of new antibiotics development are strictly linked to clinical outcomes. Adequate empirical antimicrobial therapy is fundamental to counteract bacterial resistance.
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy. Electronic address: federico.coccolini@gmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Amico
authors.affiliation: Unit of General and Emergency Surgery, Macerata Hospital, Macerata, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Sartelli
authors.affiliation: Unit of General and Emergency Surgery, Parma University Hospital, Parma, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Montori
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ceresoli
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredi
authors.affiliation: Unit of General Surgery, Maggiore Hospital, Bologna, Italy.
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
authors.affiliation: Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy; D001064:Appendicitis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D010343:Patient Admission; D010538:Peritonitis / Q000453:epidemiology / Q000382:microbiology; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology; D012772:Shock, Septic / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute appendicitis; Antibiotic; Antimicrobial; Bacteriology; Infection; Peritonitis; Spectrum; Surgery; Therapy