Usefulness of intraoperative culture swabs in laparoscopic appendectomy for complicated appendicitis
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ORIGINAL ARTICLE
Usefulness of intraoperative culture swabs in laparoscopic appendectomy for complicated appendicitis María E. Peña 1
&
Emmanuel E. Sadava 1 & Francisco Laxague 1 & Francisco Schlottmann 1
Received: 19 April 2020 / Accepted: 18 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Intraabdominal abscess (IAA) is a feared complication after laparoscopic appendectomy (LA) for complicated appendicitis. Benefits of obtaining intraoperative culture swabs (ICS) still remain controversial. We aimed to determine whether ICS modify the rate and management of IAA after LA for complicated appendicitis. Methods A consecutive series of patients who underwent LA for complicated appendicitis from 2008 to 2018 were included. The cohort was divided into two groups: group 1 (G1), with ICS, and group 2 (G2), without ICS. Demographics, operative variables, pathogen isolation, antibiotic sensitivity, and postoperative outcomes were analyzed. Results A total of 1639 LA were performed in the study period. Of these, 270 (16.5%) were complicated appendicitis; 90 (33%) belonged to G1 and 180 (67%) to G2. In G1, a higher proportion of patients had generalized peritonitis (G1, 63.3%; G2, 35%; p < 0.01). Seventy-two (80%) patients had positive cultures in G1. The most frequently isolated bacteria were E. coli (66.7%), Bacteroides spp. (34.7%), and Streptococcus spp. (19.4%). In 26 (36%) patients, the initial empiric antibiotic course was modified due to bacterial resistance. The rate of IAA was higher in patients with ICS (G1, 21.1%; G2, 9.4%; p = 0.01). IAA was treated similarly in both groups. A different type of bacteria was isolated in 7 (53.8%) patients with new culture swabs. Conclusions Obtaining ICS in LA for complicated appendicitis with further antibiotic adjustment to the initial pathogen did not lower the incidence of postoperative IAA and did not modify the treatment needed for this complication. Keywords Culture swabs . Laparoscopic appendectomy . Intraabdominal abscess . Complicated appendicitis
Introduction Acute appendicitis is one of the most common abdominal surgical procedures in the emergency setting [1]. Over the last decades, the laparoscopic approach has been widely adopted because of its many advantages, such as less postoperative pain, reduced rates of wound infection, and shorter hospital stay [2, 3]. However, postoperative intraabdominal abscess (IAA) is still one of the most feared complications after laparoscopic appendectomy (LA), especially in cases of complicated appendicitis [4, 5]. Obtaining intraabdominal fluid samples for swab culture is a common practice aimed to document the involved pathogens and thus target antibiotic therapy more precisely [6]. * María E. Peña [email protected] 1
Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, C1118AAT Buenos Aires, Argentina
Theoretically, this could help preventing infectious postoperative complications. However, there is a lack of evidence in the literature to support the s
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