Bacterial Studies of Peritoneal Cavity and Postoperative Surgical Wound Drainage Following Perforated Appendix in Children

Abstract

This study reports bacterial specimens obtained from 112 children presenting a ruptured appendix. Additional samples were studied from 11 of these patients who developed a postoperative surgical draining wound. Bacterial growth occurred in 100 peritoneal fluid specimens. Anaerobic bacteria were present in 14 specimens, aerobes alone in 12 and mixed aerobic and anaerobic flora in 74 specimens. There were 144 aerobic isolates (1.4/specimen). The predominant isolates were: Escherichia coli (57 specimens); .alpha.-hemolytic Streptococcus (16 specimens); .gamma.-hemolytic Streptococcus (15 specimens); Group D Streptococcus (12 specimens); Pseudomonas aeruginosa (9 specimens). There were 301 anaerobic isolates (3/specimen). The predominant isolates were: 157 Bacteroides spp. (including 92 B. fragilis group and 26 B. melaninogenicus group); 62 gram-positive anaerobic cocci (including 30 Peptococcus spp.; 29 Peptostreptococcus spp.); 27 Fusobacterium spp.; and 16 Clostridium spp. B. fragilis and Peptococcus spp. occurred in 23 patients. .beta.-Lactamase production was detectable in 98 isolates recovered from 74 patients. These included all isolates of B. fragilis and 6 of the 23 Bacteroides spp. Forty-nine organisms (16 aerobic and 33 anaerobic) were recovered from the draining wounds. The predominant organisms were: B. fragilis (8 specimens); E. coli (6 specimens); Peptostreptococcus spp. (5 specimens); and 3 specimens each of P. aeruginosa and Peptococcus spp. Most of these isolates were recovered from the peritoneal cavity of the patients. The polymicrobial aerobic and anaerobic nature of peritoneal cavity and postoperative wound flora in children with perforated appendix and the presence of .beta.-lactamase-producing organisms in three-fourths of the patients was demonstrated.