The Importance of Intraoperative Culture Swabs for The Management of Patients With Complicated Appendicitis Who Undergoing Laparoscopic Appendectomy

Abstract

Background: There is a controversy about the benefits of intraoperative culture swabs (IOCS) in appendectomy patients, some studies  show no efficacy of such procedures while others support its use.

Aim of the work: This study aimed to determine the epidemiological,  clinical data, isolated microorganisms, and antibiotic resistance patterns in patients who underwent Laparoscopic appendectomy (LA)  and evaluation of whether IOCS can modify the rate or management of post-appendectomy complications.

Methods: the study was  conducted on 292 patients who underwent laparoscopic appendectomy and intraoperative culture and sensitivity were done. Patients'  electronic medical records were reviewed for the relevant demographic, perioperative, and postoperative data.

Results: The most  common isolated microorganisms were E coli 36.6%, and Klebsiella species 21.25% followed by Pseudomonas 8.33% which represents  (21.27% and 5.18 % in complicated and non-complicated cases, respectively). Isolated Pseudomonas spp. and extended-spectrum beta- lactamase (ESBL) resistant Enterobacteriaceae were less frequently encountered (8.35%) but were resistant to most beta-lactam groups.  

Conclusion: 2nd generation cephalosporins and metronidazole were used as a first-line postoperative treatment in most uncomplicated cases. This treatment regimen was not effective against Pseudomonas spp and most ESBL-resistant strains. Quinolones were added to the regimen in complicated and severe cases, its use was reserved for complicated cases. A lower rate of complications  was documented among studied patients in whom IOCS were used comparable to other studies' results. The treatment protocols were  adjusted in a significant number of patients according to the result of IOCS, this reflects that its clinical implementation in routine surgical  workup is clinically justified.