RESUMO
PURPOSE: The objective of this study was to determine the association between the presence of a microorganism resistant to the antibiotic used in empirical therapy and the development of intra-abdominal abscesses in children with perforated appendicitis. METHODS: A prospective cohort study was conducted in patients under 18 years of age who underwent laparoscopic appendectomy between November 1, 2019, and September 30, 2020, in whom perforated appendicitis was documented intraoperatively. Peritoneal fluid samples were taken for bacteria culture purposes, and clinical and microbiological data were collected from all patients. RESULTS: A total of 232 patients were included in the study. The most isolated microorganisms were Escherichia coli (80.14%) and Pseudomonas aeruginosa (7.45%). In addition, 5.31% of E. coli isolates were classified as ESBL-producing organisms. No association was found between a germ resistant to empiric antimicrobial therapy and the development of a postoperative intra-abdominal abscess. Multivariate analysis showed that being a high-risk patient on admission (OR 2.89 (p = 0.01)) was associated with the development of intra-abdominal abscesses postoperatively. CONCLUSION: E. coli was the most commonly isolated microorganism, with a low rate of ESBL-producing isolates. No association between resistance and risk of postoperative intra-abdominal abscess was found. However, it was identified that being a high-risk patient on admission was associated with this complication. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level I.
Assuntos
Abscesso Abdominal , Apendicite , Criança , Humanos , Adolescente , Estudos de Coortes , Escherichia coli , Estudos Prospectivos , Apendicite/complicações , Apendicite/cirurgia , Apendicite/tratamento farmacológico , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Abscesso Abdominal/tratamento farmacológico , Apendicectomia/efeitos adversosRESUMO
Abstract Introduction: Acute appendicitis is the leading cause of abdominal surgical emergencies in pediatrics. Between 30% and 75% of cases progress to perforated appendicitis; however, timely diagnosis before perforation occurs remains a challenge. Objective: To identify predictive factors for perforated appendicitis in a pediatric population (<18 years) at the time of admission to the emergency department. Materials and methods: Prospective cohort study conducted in 193 patients (perforated appendicitis=98; non-perforated appendicitis=95) admitted to the emergency department of a pediatric referral hospital in Bogotá D.C., or referred to such hospital, who underwent appendectomy between November 1 and December 31, 2013. Bivariate analyses were performed (Student's t-tests, Mann-Whitney U, chi-square or Fisher's exact), calculating the odds ratios (OR) with their respective 95%CI. In the multivariate analysis (logistic regression), the stepwise regression method was used to select variables according to their statistical significance, and regression models were performed. The explanatory power of the models was verified by calculating the areas under the ROC curve. Results: The mean age of the participants was 9.8 years, and the prevalence of perforated appendicitis was 50.78%. The following predictive factors for perforated appendicitis were identified in the multivariate analysis: presence of emesis on admission to the emergency department (OR=4.28, 95%CI: 1.63-11.21), presence of tachycardia on physical examination (OR=3.38, 95%CI:1.69-6.59), temperature >38.3°C on physical examination (OR=3.36, 95%CI: 1.29-8.70), and duration of symptoms until surgery (OR=1.95, 95%CI: 1.37-2.77). Conclusions: In the present study, duration of symptoms until surgery, presence of emesis during questioning on admission to the emergency department, and presence of tachycardia and fever (>38.3°) on physical examination behaved as predictive factors for acute perforated appendicitis in pediatric patients.
Resumen Introducción. La apendicitis aguda es la principal causa de urgencia quirúrgica abdominal en población pediátrica. Entre 30% y 75% de los casos progresan a apendicitis perforada; sin embargo, el diagnóstico oportuno de esta condición antes de que ocurra la perforación continúa siendo un reto. Objetivo. Identificar los factores predictores de apendicitis perforada en población pediátrica (<18 años) al momento de ingreso al servicio de urgencias. Materiales y métodos. Estudio de cohortes prospectivo realizado en 193 pacientes (apendicitis perforada=98; no perforada=95) admitidos al servicio de urgencias de un hospital pediátrico de referencia en Bogotá D.C., Colombia, o remitidos a dicho hospital y a los que se les realizó apendicectomía entre noviembre 1 y diciembre 31 de 2013. Se realizaron análisis bivariados (pruebas t-Student, U de Mann-Whitney, chi cuadrado o exacta de Fisher), calculando Odds ratio (OR) con sus respectivos IC95%. En el análisis multivariado (regresión logística) se utilizó el método de regresión paso a paso para seleccionar las variables según su significancia estadística y se realizaron modelos de regresión. La capacidad de explicación de los modelos se verificó con el cálculo de áreas bajo la curva ROC. Resultados. La edad promedio de los participantes fue 9.8 años y la prevalencia de apendicitis perforada fue 50.78%. En el análisis multivariado se identificaron los siguientes factores predictores para apendicitis perforada: presencia de vómito en el interrogatorio al ingreso a urgencias (OR=4.28, IC95%: 1.63-11.21), presencia de taquicardia en el examen físico (OR=3.38, IC95: 1.69-6.59), temperatura >38.3°C en el examen físico (OR=3.36, IC95%: 1.29-8.70) y la duración de los síntomas hasta la cirugía (OR=1.95, IC95%: 1.37-2.77). Conclusiones. En este estudio, la duración de los síntomas hasta la cirugía, la presencia de vómito en el interrogatorio al ingreso a urgencias y la presencia de taquicardia y de fiebre (>38.3°C) al examen físico se comportaron como factores predictores de apendicitis aguda perforada en pacientes pediátricos.
RESUMO
Abstract Introduction: Appendicitis can be classified as non-perforated and perforated; based on such classification, the reported organ-space surgical site infection (OS-SSI) rate is 0.8% and 18%, respectively. Objective: To establish the prevalence of OS-SSI in patients with perforated appendicitis treated in a pediatric hospital in 2012. Materials and methods: Retrospective, observational and descriptive study conducted at Fundación Hospital Pediátrico La Misericordia, with a random sample of200 patients, ofwhich 160 met the inclusion criteria. Results: 20 patients (12.5%) presented with OS-SSI and all of them received antibiotic treatment; 70% did not require abscess drainage. Patients ≥8 years of age had 5 times more abscesses than younger ones (17.6% vs. 3.4%). OS-SSI was found in 33% of patients with free fecalith and in 50% of the patients who required postoperative management at the ICU vs. 9.5% of the patients who received management in the intermediate care unit and the inpatient hospital floors. The total rate of surgical site infection was 24.3% (11.8% superficial, 0% deep and 12.5% organ-space). Conclusions: The prevalence of OS-SSI found here is lower than what has been reported in the literature. Being 8 years or older and having free fecalith are risk factors to develop this type of infection. The higher frequency of OS-SSI in patients treated at the ICU during the post-operative period observed here suggests that this condition may be associated with septic shock.
Resumen Introducción. La apendicitis se clasifica en no perforada y perforada; de acuerdo a esta clasificación, la tasa de infección del sitio operatorio órgano-espacio (ISO-OE) es de 0.8% y 18%, respectivamente. Objetivo. Determinar la prevalencia de ISO-OE en pacientes con apendicitis perforada en un hospital pediátrico en 2012. Materiales y métodos. Estudio retrospectivo y observacional descriptivo de corte transversal. La muestra fue aleatoria y de 200 pacientes, 160 cumplieron los criterios de inclusión. Resultados. Los 20 pacientes (12.5%) que presentaron ISO-OE recibieron manejo antibiótico; 70% no requirió drenaje de colección. Los pacientes ≥8 años presentaron 5 veces más ISO-OE (17.6% vs. 3.4%). El 33% de los pacientes con fecalito en cavidad y el 50% que se hospitalizó en post-operatorio inmediato en la unidad de cuidados intensivos (UCI) desarrollaron ISO-OE versus 9.5% de los pacientes atendidos en la unidad de cuidados intermedios y pisos. El total de ISO fue 24.3%: 11.8% superficial, 0% profunda y 12.5% de órgano-espacio. Conclusiones. La prevalencia de ISO-OE encontrada es menor a la reportada en la literatura. La edad ≥8 años y el fecalito en cavidad son factores de riesgo para desarrollar este tipo de infección. La mayor frecuencia de ISO-OE en pacientes manejados en el posoperatorio en UCI sugiere que esta condición puede estar asociada con el choque séptico.