TY - JOUR
TI - Microbial Epidemiology of Acute and Perforated Appendicitis: A Post-Hoc
Analysis of an EAST Multicenter Study
AU - Jawad, Khaled Abdul
AU - Qian, Sinong
AU - Vasileiou, Georgia and
AU - Larentzakis, Andreas
AU - Rattan, Rishi
AU - Dodgion, Chris
AU - Kaafarani,
AU - Haytham
AU - Zielinski, Martin
AU - Namias, Nicholas
AU - Yeh, D. Dante and
AU - EAST Appendicitis Res Grp
JO - Journal of Surgical Research
PY - 2022
VL - 269
TODO - null
SP - 69-75
PB - ACADEMIC PRESS INC ELSEVIER SCIENCE
SN - 0022-4804, 1095-8673
TODO - 10.1016/j.jss.2021.07.026
TODO - appendicitis; microbiota; epidemiology; bacteria; antibiotics
TODO - Background: There are significant practice variations in antibiotic
treatment for appendicitis, ranging from short-course narrow spectrum to
long-course broad-spectrum. We sought to describe the modern microbial
epidemiology of acute and perforated appendicitis in adults to help
inform appropriate empiric coverage and support antibiotic stewardship
initiatives. Methods: This is a post-hoc secondary analysis of the
Multicenter Study of the Treatment of Appendicitis in America: Acute,
Perforated, and Gangrenous (MUSTANG) which prospectively enrolled adult
patients (age >= 18 years) diagnosed with appendicitis between January
2017 and June 2018 across 28 centers in the United States. We included
all subjects with positive microbiologic cultures during primary or
secondary (rescue after medical failure) appendectomy or percutaneous
drainage. Culture yield was compared between low-and high-grade
appendicitis as per the AAST classification. Results: A total of 3,471
patients were included: 230 (7%) had cultures performed, and 179/230
(78%) had positive results. Cultures were less likely to be positive in
grade 1 compared to grades 3, 4, or 5 appendicitis with 2/18 (11%) vs
61/70 (87%) (p < .001). Only 1 subject had grade 2 appendicitis and
culture results were negative. E. coli was the most common pathogen and
cultured in 29 (46%) of primary appendectomy samples, 16 (50%) of
secondary, and 44 (52%) of percutaneous drainage samples. Conclusion:
Culturing low-grade appendicitis is low yield. E. coli is the most
commonly cul-tured microbe in acute and perforated appendicitis. This
data helps inform empiric coverage for both antibiotics alone and as an
adjunct to operative or percutaneous intervention. (c) 2021 Published by
Elsevier Inc.
ER -