Significance of Pseudomonas in perforated appendicitis in children

This study was done to determine perioperative antibiotic therapy for children suspected of having a ruptured appendicitis based on intraoperative peritoneal cultures. The medical records of 120 patients less than 18 years of age who required surgery for appendicitis were reviewed to determine the organisms present in the peritoneal fluid. Forty-five (37%) of 120 patients had a perforated appendicitis, and 75 (63%) had not perforated. Forty-two of the 45 cases with rupture and 49 of the 75 cases without rupture had peritoneal fluid culture reports. Thirty-five (83%) of the positive peritoneal fluid cultures occurred in association with perforation; 7 (17%) patients with nonruptured appendicitis had positive cultures. Pseudomonas aeruginosa was isolated from the peritoneal fluid of 29% (12 of 42) of the children with perforation and from none with nonrupture (p <,0.001). Physicians involved in the perioperative management of pediatric patients suspected of having appendicitis with perforation should consider using an antibiotic with anti-Pseudomonal activity.