Bacterial profile and antibiotic resistance in pediatric appendicitis: retrospective analysis and associated laboratory and clinical findings

Abstract

Introduction: Identifying the bacterial profile in acute appendicitis, which is a common paediatric surgical emergency, can guide antibiotic therapy and improve outcomes. Therefore, the objective of this study is to evaluate the bacterial profile in paediatric appendicitis and its association with clinical and laboratory findings.

Methodology: A retrospective study was conducted on paediatric patients (≤ 14 years) who underwent appendectomy at King Fahad Hospital, Al-Baha, from 1 January 2019 to 1 October 2023. Data collected included demographics, clinical presentation, laboratory results, intraoperative findings, bacterial cultures, antibiotic regimens, and outcomes. Kruskal–Wallis and Mann–Whitney tests were performed. The normality of the data was evaluated using the Kolmogorov–Smirnov and Shapiro–Wilk tests. A p < 0.05 was considered statistically significant.

Results: In 170 patients (mean age of 10.02 years; 62.9% male), the prevalent symptoms were right lower quadrant pain (94.7%) and nausea or vomiting (80.6%). Preoperative antibiotics were administered in 91.8% of the patients. Peritoneal fluid cultures were positive in 28.8%, and Escherichia coli was the dominant isolate (60.2%). Antibiotic resistance was significantly associated with elevated white blood cell count (p = 0.003), high polymorphonuclear granulocytes (p = 0.032), abscess formation (p = 0.008), and perforation (p = 0.016). The mean hospital stay was 4.5 days, and postoperative complications occurred in 1.8% of patients.

Conclusions: E. coli is the predominant pathogen in paediatric appendicitis, with significant resistance in complicated cases. Tailored antibiotic therapy is crucial to reducing complications, but more studies are needed to refine empirical antibiotic selection.