Impact of Percutaneous Drainage on Outcome of Intra-abdominal Infection Associated With Pediatric Perforated Appendicitis.
BACKGROUND
Perforated appendicitis can result in potentially serious complications requiring prolonged medical care. The optimal approach to successfully managing this condition is controversial.


METHODS
Review of 80 consecutive cases of pediatric acute perforated appendicitis with intra-abdominal infection (IAI) medically managed with parenteral antibiotics and percutaneous drainage (PD) during a 7-year period.


RESULTS
All patients received broad spectrum parenteral antibiotic therapy. One-third were hospitalized for >2 weeks. IAI was identified on admission in 60% compared with developing during hospitalization in 40% of cases. Before performing PD, the mean duration of antibiotic therapy in those who developed IAI during hospitalization was 6 days. IAI cultures yielded 127 bacterial isolates; polymicrobial infection occurred in 65% of cases. Only 7% of aspirates were sterile. The most common pathogens were Escherichia coli (82%), of which 5 isolates exhibited extended-spectrum β-lactamase production, and streptococci (40%). At the time of PD, 60% were febrile (mean duration of in-hospital fever, 7.5 days); 67% defervesced within 24 hours after the procedure. Posthospitalization abdominal complications (recurrent IAI or appendicitis) occurred in one-third of patients.


CONCLUSIONS
Children with perforated appendicitis and IAI often have a complicated and prolonged clinical course. Medical management consisting solely of parenteral antibiotic therapy is frequently ineffective in resolving IAI. Rapid clinical improvement commonly follows PD.
From the Departments of Emergency Medicine and Pediatrics, Maimonides Medical Center, Brooklyn, New York.
William
W
Bonadio
Miriam
M
Langer
Julie
J
Cueva
Astrid
A
Haaland
D001064:Appendicitis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D002648:Child; D004322:Drainage / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome