Mehmet Gazi ÖZTÜRK, Musa ABEŞ, Mehmet SARAÇ, Mehmet Selim ALBAYRAK, Hasan Öğünç APAYDIN, Mehmet GÖKSU, Muhammed İkbal YETİŞ, Sadık AKGÜN
The Turkish Journal of Pediatrics - 2026;68(3):485-494
Background. This study retrospectively evaluates the microbiological profile, antibiotic susceptibility patterns, and the effectiveness of empirically initiated antibiotic therapies in children with perforated appendicitis, based on intraoperative peritoneal fluid culture and antibiogram results. Methods. A total of 154 pediatric patients (97 boys, 57 girls; mean age 9.15 +/- 4.08 years) underwent surgery for perforated appendicitis between 2014 and 2020. Before surgery, patients received one of three empirical antibiotic combinations: (1) Ampicillin/sulbactam, metronidazole, and amikacin; (2) ceftriaxone and metronidazole; (3) cefotaxime and metronidazole. Peritoneal fluid samples collected intraoperatively were cultured, and microbial growth and susceptibility profiles were analyzed. Results. A total of 167 strains were isolated. The most common microorganisms were Escherichia coli (79.0%), Pseudomonas aeruginosa (13.8%), Klebsiella pneumoniae (2.4%), Enterobacter cloacae (1.8%), Enterococcus raffinosus (2.4%), and Staphylococcus hominis (0.6%). Before surgery, Combination 1 was administered to 97 patients (63.0%), Combination 2 to 38 patients (24.7%), and Combination 3 to 19 patients (12.3%). Antibiotic susceptibility of the isolated microorganisms was as follows. E. coli: ampicillin/sulbactam 23%, ceftriaxone 60%, cefotaxime 92%, amikacin 99%. P. aeruginosa: ampicillin/sulbactam 8%, ceftriaxone 16%, cefotaxime 0%, amikacin 99%. K. pneumoniae: ceftriaxone 75%, cefotaxime 75%, amikacin 100%. E. raffinosus: ceftriaxone 33%, cefotaxime 100%, amikacin 100%. Postoperative modification of empirical therapy was required in 102 cases (66.2%) Conclusions. High resistance rates to commonly used empirical antibiotics were observed among isolated microorganisms, highlighting the need for regular revision of empirical treatment protocols and greater reliance on intraoperative culture results in pediatric perforated appendicitis.
