{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T06:19:29Z","timestamp":1787552369823,"version":"build-2736575974"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute appendicitis is one of the most common surgical emergencies in children, and timely empirical antimicrobial therapy is particularly important in complicated cases. However, antibiotic selection is increasingly challenged by regional variability in pathogen distribution and antimicrobial resistance. This study aimed to characterize the microbiological spectrum and antimicrobial susceptibility profiles of purulent specimens from pediatric patients with acute appendicitis and to provide evidence for optimized empirical therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective observational study, intraoperative purulent specimens were collected from 70 consecutive pediatric patients diagnosed with acute appendicitis between January 2024 and January 2025 at the Second Affiliated Hospital of Fuyang Normal University. All patients received a standardized preoperative antimicrobial regimen (cefuroxime 50\u2005mg\/kg plus metronidazole 7.5\u2005mg\/kg, administered intravenously within 30\u201360\u2005min before surgical incision), which was documented for each case. Bacterial identification was performed using the VITEK\u00ae 2 Compact system. Antimicrobial susceptibility testing was conducted by broth microdilution in accordance with current Clinical and Laboratory Standards Institute (CLSI) guidelines. Extended-spectrum\n                      <jats:italic>\u03b2<\/jats:italic>\n                      -lactamase (ESBL) production was confirmed by the double-disk synergy test. Appendectomy specimens were independently evaluated by two board-certified pathologists according to predefined histopathological criteria.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pathogens were isolated from 62 of 70 specimens, yielding a culture-positive rate of 88.6%. Gram-negative bacteria predominated (98.3%), whereas only one Gram-positive isolate was identified.\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      was the most common pathogen (74.2%), followed by\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      (14.5%). Among\n                      <jats:italic>E. coli<\/jats:italic>\n                      isolates, 41.3% were ESBL producers.\n                      <jats:italic>E. coli<\/jats:italic>\n                      remained highly susceptible to amikacin and imipenem, but showed substantial resistance to co-trimoxazole and ceftriaxone. All\n                      <jats:italic>P. aeruginosa<\/jats:italic>\n                      isolates were susceptible to the tested antimicrobial agents. As a secondary descriptive outcome, acute appendicitis with peritonitis was the most frequent pathological subtype, accounting for 67.1% of the included cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Pediatric acute appendicitis in this cohort was dominated by Gram-negative pathogens, particularly ESBL-producing\n                      <jats:italic>E. coli<\/jats:italic>\n                      . The findings should be interpreted in the context of the study's aerobic culture methodology, which may have limited recovery of anaerobic organisms. These findings support the use of local resistance surveillance to guide severity-based empirical antibiotic selection, especially in complicated appendicitis.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1883281","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:30:53Z","timestamp":1787549453000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Microbiological spectrum and antimicrobial resistance patterns in pediatric acute appendicitis: implications for evidence-based empirical therapy"],"prefix":"10.3389","volume":"14","author":[{"given":"Jia","family":"Zhang","sequence":"first","affiliation":[{"name":"Key Surgical Laboratory of Educational Administration of Liaoning Province, First Affiliated Hospital of Jinzhou Medical University, Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaiwei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, The Second Affiliated Hospital of Fuyang Normal University, Fuyang Normal University","place":["Fuyang, Anhui, China"]},{"name":"Department of Pediatric Surgery, The Second Affiliated Hospital of Fuyang Normal University, Fuyang Normal University","place":["Fuyang, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Peng","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, The Second Affiliated Hospital of Fuyang Normal University, Fuyang Normal University","place":["Fuyang, Anhui, China"]},{"name":"Department of Pediatric Surgery, The Second Affiliated Hospital of Fuyang Normal University, Fuyang Normal University","place":["Fuyang, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubin","family":"Li","sequence":"additional","affiliation":[{"name":"Key Surgical Laboratory of Educational Administration of Liaoning Province, First Affiliated Hospital of Jinzhou Medical University, Jinzhou Medical University","place":["Jinzhou, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1186\/s12893-025-03015-3","article-title":"Development of a new predictive clinico-biological score for acute appendicitis in the pediatric population","volume":"25","author":"Youssef","year":"2025","journal-title":"Bmc Surgery"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1718","DOI":"10.1016\/j.jpedsurg.2020.11.014","article-title":"Additional prophylactic antibiotics do not decrease surgical site infection rates in pediatric patients with appendicitis and cholecystitis","volume":"56","author":"Stokes","year":"2021","journal-title":"J Pediatr Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2203","DOI":"10.3201\/eid2911.230211","article-title":"Group A Streptococcus primary peritonitis in children, New Zealand","volume":"29","author":"Taylor","year":"2023","journal-title":"Emerg Infect Dis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12941-023-00591-1","article-title":"Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial management","volume":"22","author":"Bhaskar","year":"2023","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"B5","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/s00383-022-05284-y","article-title":"Non-operative management of acute appendicitis in children","volume":"39","author":"Jumah","year":"2023","journal-title":"Pediatr Surg Int"},{"key":"B6","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1007\/s00423-024-03367-z","article-title":"Antibiotic treatment after appendectomy for acute complicated appendicitis to prevent intrabdominal abscess and wound infections","volume":"409","author":"Laverde","year":"2024","journal-title":"Langenbecks Arch Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2314","DOI":"10.1177\/00031348241248815","article-title":"The impact of redosing antibiotics for pediatric patients undergoing appendectomy for complicated appendicitis","volume":"90","author":"Motta","year":"2024","journal-title":"Am Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1504487","DOI":"10.3389\/fmicb.2024.1504487","article-title":"Comparative evaluation of specimen type and processing conditions for studying oyster microbiomes","volume":"15","author":"Almuhaideb","year":"2025","journal-title":"Front Microbiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.mcna.2025.01.003","article-title":"Management of severe infections multidrug-resistant and carbapenem-resistant gram-negative Bacteria","volume":"109","author":"Perez","year":"2025","journal-title":"Med Clin N Am"},{"key":"B10","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1089\/sur.2024.304","article-title":"Antimicrobial stewardship impact on the treatment of intra-abdominal infections in the surgical intensive care unit","volume":"26","author":"Peterson","year":"2025","journal-title":"Surg Infect"},{"key":"B11","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1038\/s41429-024-00761-z","article-title":"Investigation of plasmid-mediated quinolone resistance among extended-spectrum \u03b2-lactamase isolates of E. coli and K. pneumoniae","volume":"77","author":"Kadry","year":"2024","journal-title":"J Antibiot"},{"key":"B12","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s00430-022-00749-2","article-title":"Resistance to fosfomycin is increasing and is significantly associated with extended-spectrum \u03b2-lactamase-production in urinary isolates of Escherichia coli","volume":"211","author":"Rios","year":"2022","journal-title":"Med Microbiol Immunol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1097\/inf.0000000000004800","article-title":"Microbiologic and clinical characteristics of pediatric appendicitis: a retrospective cohort study on antibiotic resistance and treatment options","volume":"44","author":"Adhehani","year":"2025","journal-title":"Pediatr Infect Dis J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1055\/a-2540-3690","article-title":"Rising multidrug-resistant pathogens in pediatric appendicitis: a decade-long study from southern Israel","volume":"35","author":"Melamed","year":"","journal-title":"Eur J Pediatr Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s00383-023-05570-3","article-title":"Association between bacterial resistance profile and the development of intra-abdominal abscesses in pediatric patients with perforated appendicitis: cohort study","volume":"40","author":"Garzon-Gonz\u00e1lez","year":"2023","journal-title":"Pediatr Surg Int"},{"key":"B16","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s12887-026-06535-w","article-title":"Diagnostic value of pediatric appendicitis score for complicated appendicitis in preschool children","volume":"26","author":"Ding","year":"2026","journal-title":"Bmc Pediatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"223","DOI":"10.3343\/alm.2024.0369","article-title":"Clinical outcomes and molecular characteristics of Bacteroides fragilis infections","volume":"45","author":"Kim","year":"2025","journal-title":"Ann Lab Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1573614","DOI":"10.3389\/fmicb.2025.1573614","article-title":"Prevalence and characterization of ESBL-producing diarrheagenic Escherichia coli from the poultry industry in Shanghai, China","volume":"16","author":"Que","year":"2025","journal-title":"Front Microbiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1186\/s12879-024-10096-7","article-title":"Molecular identification and antimicrobial resistance patterns of enterobacterales in community urinary tract infections among Indigenous women in Ecuador: addressing microbiological misidentification","volume":"24","author":"Bastidas-Caldes","year":"2024","journal-title":"Bmc Infect Dis"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1202752","DOI":"10.3389\/fmicb.2023.1202752","article-title":"Recent advances in microbiological and molecular biological detection techniques of tuberculous meningitis","volume":"14","author":"Cao","year":"2023","journal-title":"Front Microbiol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1883281\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:30:53Z","timestamp":1787549453000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1883281\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":20,"alternative-id":["10.3389\/fped.2026.1883281"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1883281","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"1883281"}}