1309. Bacteriology, antibiotic susceptibility and empirical antibiotics of community-acquired perforated appendicitis
Session: Poster Abstract Session: Below the Diaphragm
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Complicated intra-abdominal infection is common problem, for which antimicrobial selection should be based on local microbiologic data. The aim of this study was to study bacteriology and changing antibiotic susceptibilities of pathogens in patients of community-acquired perforated appendicitis over 12-year-period.

Methods: We retrospectively reviewed the records of adult patients (age ≥18 years) who were diagnosed to have perforated appendicitis at Ulsan University Hospital between January 2000 to December 2011. Patients who had healthcare-associated or hospital-acquired appendicitis were excluded. Intraoperative specimens submitted to the microbiology laboratory were obtained either by aspiration of the pus into a syringe or by a swab.


We analyzed 415 culture-positive cases with perforated appendicitis. The overall mortality rate of patients was 0.2% (1/415). Escherichia. coli was the most common pathogen (277/415, 66.7%), followed by Streptococcus spp. (61/415, 14.7%), Enterococcus spp. (32/415, 7.7%), Klebsiella spp. (25/415, 6.0%) Pseudomonas aeroginosa (24/415, 5.8%). The overall susceptibility of E. coli to quinolones (ciprofloxacin or levofloxacin) was 79.1%. The susceptibility of E. coli to ampicillin, cefazolin, ceftriaxone, amikacin, gentamicin, piperacillin/tazobactam and carbapenem reached 35.1%, 85.5%, 95.3%, 98.6%, 82.2%, 97.2%, 100%, respectively. During the study period, there was a significant increase in quinolone resistance of E. coli on univariate logistic regression analysis (OR=1.094;  p=0.039).


E. coli was the most common pathogen of community-acquired perforated appendicitis. Quinolone resistance of E. coli was greater than 20% and showed statistically significant increasing trend. We cannot recommend quinolones for use as empirical therapy for perforated appendicitis.

Jae-Bum Jun, Department of Internal Medicine, Ulsan University College of Medicine, Ulsan, South Korea and Min Hyok Jeon, MD, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea


J. B. Jun, None

M. H. Jeon, None

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