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August 1994

Escherichia coli Septicemia in Nonperforated Appendicitis

Arch Pediatr Adolesc Med. 1994;148(8):853-855. doi:10.1001/archpedi.1994.02170080083016

Objective:  To determine the association between nonperforated appendicitis and Escherichia coli septicemia, and the frequency with which blood cultures are obtained in the clinical setting of appendicitis.

Design:  Three case reports of E coli septicemia and nonperforated appendicitis and a retrospective survey.

Setting:  Children's Medical Center, Dallas, Tex, a primary care and tertiary referral center.

Patients:  All children admitted in a 2-year period with a diagnosis of appendicitis.

Interventions:  None.

Results:  Preoperative blood cultures were obtained in 20 (21%) of 96 patients with histologic evidence of appendicitis. Fifty percent of the patients had gross or microscopic evidence of appendiceal perforation. Twelve (25%) of the 48 patients with perforated appendicitis had blood cultures obtained before the initiation of antimicrobial therapy, and in two of these patients (17%) the results were positive. Blood cultures were drawn before antibiotic therapy in four (8%) of the 48 patients with nonperforated appendicitis, and in two of these the results were positive. The blood culture isolates (coagulase-negative Staphylococcus and E coli) were the same in both groups.

Conclusions:  Nonperforated appendicitis and septicemia may be more common than formerly appreciated. Only a prospective study can determine the true incidence of septicemia in children with perforated or nonperforated appendicitis.(Arch Pediatr Adolesc Med. 1994;148:853-855)