Download PDF
Eur J Pediatr Surg 2016; 26(03): 267-272
DOI: 10.1055/s-0035-1551571
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Failure of First-Line Antibiotics in Nonoperative Management of Appendiceal Mass, toward a Second-Line Instead of Surgery?

Benoît Parmentier
1   General Pediatric Surgery, Robert Debré Children University Hospital, Paris, France
,
Dominique Berrebi
2   Department of Pediatric Pathology, Robert Debré Children University Hospital, Paris, France
,
Matthieu Peycelon
1   General Pediatric Surgery, Robert Debré Children University Hospital, Paris, France
,
Catherine Doit
3   Department of Microbiology, Robert Debré Children University Hospital, Paris, France
,
Alaa El Ghoneimi
1   General Pediatric Surgery, Robert Debré Children University Hospital, Paris, France
,
Arnaud Bonnard
1   General Pediatric Surgery, Robert Debré Children University Hospital, Paris, France
› Author Affiliations
Further Information

Publication History

05 October 2014

15 February 2015

Publication Date:
19 May 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Background Conservative approach for complicated appendicitis has been gradually adopted in children to decrease postoperative morbidity. The first aim of this study was to assess the efficacy of a second-line antibiotics enlarged on Pseudomonas aeruginosa and Enterococcus in case of poor clinical outcome after initial conservative approach for appendiceal mass and abscess. The second aim of this study was to identify predictive factors of failure of first-line antibiotics.

Methods We performed a prospective review of all the cases of appendiceal mass or abscess managed at our institution between November 2007 and September 2011 after implementation of a conservative protocol including a second-line antibiotics in case of poor initial clinical outcome.

Results A total of 64 consecutive patients were included. We observed a success in 46 patients after the first-line antibiotics and in 14 of the remaining patients after the second-line. The only predictive factor of failure of the first-line antibiotics was a shorter duration of symptoms before admission (p = 0.02). Laparoscopic appendectomy was performed in all the cases (emergency or interval procedure) with six postoperative complications and two conversions to open surgery.

Conclusions A gradual adapted antibiotherapy in nonoperative management of appendiceal abscess and mass is effective. We found no relevant predictive factor of failure of the first-line antibiotics.

Keywords

children - appendicular mass - appendicular abscess - nonoperative management - antibiotics
 

  • References

  • 1 Sømme S, Bronsert M, Morrato E, Ziegler M. Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics 2013; 132 (6) e1466-e1472
    CrossrefPubMedGoogle Scholar
  • 2 Lee SL, Stark R, Yaghoubian A, Shekherdimian S, Kaji A. Does age affect the outcomes and management of pediatric appendicitis?. J Pediatr Surg 2011; 46 (12) 2342-2345
    CrossrefPubMedGoogle Scholar
  • 3 Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery 2010; 147 (6) 818-829
    CrossrefPubMedGoogle Scholar
  • 4 Chen C, Botelho C, Cooper A, Hibberd P, Parsons SK. Current practice patterns in the treatment of perforated appendicitis in children. J Am Coll Surg 2003; 196 (2) 212-221
    CrossrefPubMedGoogle Scholar
  • 5 Andersson RE, Petzold MG. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg 2007; 246 (5) 741-748
    CrossrefPubMedGoogle Scholar
  • 6 Aranda-Narváez JM, González-Sánchez AJ, Marín-Camero N , et al. Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon. Rev Esp Enferm Dig 2010; 102 (11) 648-652
    PubMedGoogle Scholar
  • 7 Emil S, Duong S. Antibiotic therapy and interval appendectomy for perforated appendicitis in children: a selective approach. Am Surg 2007; 73 (9) 917-922
    PubMedGoogle Scholar
  • 8 Whyte C, Levin T, Harris BH. Early decisions in perforated appendicitis in children: lessons from a study of nonoperative management. J Pediatr Surg 2008; 43 (8) 1459-1463
    CrossrefPubMedGoogle Scholar
  • 9 Henry MCW, Gollin G, Islam S , et al. Matched analysis of nonoperative management vs immediate appendectomy for perforated appendicitis. J Pediatr Surg 2007; 42 (1) 19-23 , discussion 23–24
    CrossrefPubMedGoogle Scholar
  • 10 Aprahamian CJ, Barnhart DC, Bledsoe SE, Vaid Y, Harmon CM. Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences. J Pediatr Surg 2007; 42 (6) 934-938 , discussion 938
    CrossrefPubMedGoogle Scholar
  • 11 Keckler SJ, Tsao K, Sharp SW, Ostlie DJ, Holcomb III GW, St Peter SD. Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess. J Pediatr Surg 2008; 43 (6) 977-980
    CrossrefPubMedGoogle Scholar
  • 12 Vons C. Peut-on traiter une appendicite aiguë par des antibiotiques et dans quelles conditions?. J Chir (Paris) 2009; 146 (Spec No 1) 17-21
    CrossrefPubMedGoogle Scholar
  • 13 St Peter SD, Aguayo P, Fraser JD , et al. Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. J Pediatr Surg 2010; 45 (1) 236-240
    CrossrefPubMedGoogle Scholar
  • 14 Partrick DA. Prospective evaluation of a primary laparoscopic approach for children presenting with simple or complicated appendicitis. Am J Surg 2006; 192 (6) 750-755
    CrossrefPubMedGoogle Scholar
  • 15 Abeş M, Petik B, Kazıl S. Nonoperative treatment of acute appendicitis in children. J Pediatr Surg 2007; 42 (8) 1439-1442
    CrossrefPubMedGoogle Scholar
  • 16 Vons C, Barry C, Maitre S , et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet 2011; 377 (9777) 1573-1579
    CrossrefPubMedGoogle Scholar
  • 17 Erdoğan D, Karaman I, Narcı A , et al. Comparison of two methods for the management of appendicular mass in children. Pediatr Surg Int 2005; 21 (2) 81-83
    CrossrefPubMedGoogle Scholar
  • 18 Lee SL, Islam S, Cassidy LD, Abdullah F, Arca MJ ; 2010 American Pediatric Surgical Association Outcomes and Clinical Trials Committee. Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg 2010; 45 (11) 2181-2185
    CrossrefPubMedGoogle Scholar
  • 19 Chen C-Y, Chen Y-C, Pu H-N, Tsai CH, Chen WT, Lin CH. Bacteriology of acute appendicitis and its implication for the use of prophylactic antibiotics. Surg Infect (Larchmt) 2012; 13 (6) 383-390
    CrossrefPubMedGoogle Scholar
  • 20 Yellin AE, Heseltine PN, Berne TV , et al. The role of Pseudomonas species in patients treated with ampicillin and Sulbactam for gangrenous and perforated appendicitis. Surg Gynecol Obstet 1985; 161 (4) 303-307
    PubMedGoogle Scholar
  • 21 Muehlstedt SG, Pham TQ, Schmeling DJ. The management of pediatric appendicitis: a survey of North American Pediatric Surgeons. J Pediatr Surg 2004; 39 (6) 875-879 , discussion 875–879
    CrossrefPubMedGoogle Scholar
  • 22 Andersson RE. The role of antibiotic therapy in the management of acute appendicitis. Curr Infect Dis Rep 2013; 15 (1) 10-13
    CrossrefPubMedGoogle Scholar
  • 23 Lob SH, Badal RE, Bouchillon SK, Hawser SP, Hackel MA, Hoban DJ. Epidemiology and susceptibility of Gram-negative appendicitis pathogens: SMART 2008-2010. Surg Infect (Larchmt) 2013; 14 (2) 203-208
    CrossrefPubMedGoogle Scholar
  • 24 Schmitt F, Clermidi P, Dorsi M, Cocquerelle V, Gomes CF, Becmeur F. Bacterial studies of complicated appendicitis over a 20-year period and their impact on empirical antibiotic treatment. J Pediatr Surg 2012; 47 (11) 2055-2062
    CrossrefPubMedGoogle Scholar
  • 25 Irfan M, Hogan AM, Gately R , et al. Management of the acute appendix mass: a survey of surgical practice. Ir Med J 2012; 105 (9) 303-305
    PubMedGoogle Scholar