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August 1994

Escherichia coli Septicemia in Nonperforated Appendicitis

Author Affiliations

From the Departments of Pediatrics, Ireland Army Hospital, Ft Knox, Ky (Dr Ruff), and The University of Texas Southwestern Medical Center at Dallas (Drs Friedland and Hickey). Dr Ruff is now in private practice in Jasper, Ind.

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)