ESCHERICHIA-COLI SEPTICEMIA IN NONPERFORATED APPENDICITIS

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.