{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:29:35Z","timestamp":1791480575759,"version":"4.3.4"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,8,23]],"date-time":"2022-08-23T00:00:00Z","timestamp":1661212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Latvian Academy of Science"},{"name":"Riga Stradins University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives. The aim of this study is to determine the prevailing microbiota in samples from pediatric patients with acute appendicitis, as well as evaluate the antibacterial sensitivity of the isolated microorganisms, comparing the data obtained with the clinic\u2019s antibacterial therapy guidelines. Materials and Methods. The study group consisted of 93 patients between the ages of 7 and 18. All patients underwent a laparoscopic or conventional appendectomy. The children were hospitalized with signs and symptoms suggestive of acute appendicitis. Microbiological cultures from the appendix and abdominal cavity were collected intraoperatively. Results. E. coli was identified in most cases irrespective of the clinical presentation of acute appendicitis. Most strains were susceptible to ampicillin and amoxicillin\/clavulanic acid. Five strains of E. coli produced extended spectrum beta-lactamase (ESBL). Pseudomonas aeruginosa (P. aeruginosa) was the second most commonly isolated causative agent. Furthermore, it was common in cases of acute complex appendicitis. Most strains of P. aeruginosa were resistant to amoxicillin\/clavulanic acid, ertapenem, ampicillin and cefotaxime, yet were susceptible to ceftazidime. Regardless of the clinical presentation, the samples yielded mixed isolates. Conclusion. E. coli is the main causative agent of acute appendicitis in the pediatric population displaying susceptibility to various antibiotics. P. aeruginosa was more prevalent in cases of acute complex appendicitis. P. aeruginosa isolates were susceptible to ceftazidime; however, they were resistant to cefotaxime, which should, therefore, be removed from guidelines for empirical antibacterial treatment of acute appendicitis due to phenotypic resistance of P. aeruginosa. We recommend antibiotics with distinct implementation to avoid antibiotic resistance.<\/jats:p>","DOI":"10.3390\/medicina58091144","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:22:48Z","timestamp":1661300568000},"page":"1144","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Microbiota Assessment of Pediatric Simple and Complex Acute Appendicitis"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5765-8207","authenticated-orcid":false,"given":"Mohit","family":"Kakar","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Children\u2019s Clinical University Hospital, LV-1004 Riga, Latvia"},{"name":"Department of Pediatric Surgery, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3671-1213","authenticated-orcid":false,"given":"Aigars","family":"Reinis","sequence":"additional","affiliation":[{"name":"Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0805-7063","authenticated-orcid":false,"given":"Juta","family":"Kroica","sequence":"additional","affiliation":[{"name":"Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8749-751X","authenticated-orcid":false,"given":"Arnis","family":"Engelis","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Children\u2019s Clinical University Hospital, LV-1004 Riga, Latvia"},{"name":"Department of Pediatric Surgery, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renars","family":"Broks","sequence":"additional","affiliation":[{"name":"Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lasma","family":"Asare","sequence":"additional","affiliation":[{"name":"Statistics Unit, Riga Stradins University, LV-1046 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marelize","family":"Vermeulen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3087-3633","authenticated-orcid":false,"given":"Simone Oliver","family":"Senica","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amulya","family":"Saxena","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Chelsea Children\u2019s Hospital, Chelsea and Westminster NHS Fdn Trust, Imperial College London, London SW10 9NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aigars","family":"Petersons","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Children\u2019s Clinical University Hospital, LV-1004 Riga, Latvia"},{"name":"Department of Pediatric Surgery, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"510","DOI":"10.5223\/pghn.2021.24.6.510","article-title":"Optimal First-Line Antibiotic Treatment for Pediatric Complicated Appendicitis Based on Peritoneal Fluid Culture","volume":"24","author":"Aiyoshi","year":"2021","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"828748","DOI":"10.3389\/fped.2022.828748","article-title":"Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis","volume":"10","author":"Bhattacharya","year":"2022","journal-title":"Front. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e9518","DOI":"10.1097\/MD.0000000000009518","article-title":"The intra- and extraluminal appendiceal microbiome in pediatric patients","volume":"96","author":"Schulin","year":"2017","journal-title":"Medicine"},{"key":"ref_4","unstructured":"European Committee on Antimicrobial Susceptibility Testing (2020, December 10). Clinical Breakpoints and Dosing of Antibiotics. Available online: http:\/\/www.eucast.org\/clinical_breakpoints\/."},{"key":"ref_5","first-page":"8","article-title":"Bacterial Pattern in Acute Appendicitis","volume":"15","author":"Abdussemee","year":"2018","journal-title":"Ann. Afr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.18203\/2349-2902.isj20172768","article-title":"A study on microbiology culture of acute appendicectomy specimen and its correlation with wound infection","volume":"4","author":"Parthiban","year":"2017","journal-title":"Int. Surg. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s00384-018-2992-z","article-title":"Bacterial culture and antibiotic susceptibility in patients with acute appendicitis","volume":"33","author":"Song","year":"2018","journal-title":"Int. J. Colorectal. Dis."},{"key":"ref_8","unstructured":"(2022, June 29). Rekomend\u0101cijas Antibakteri\u0101lo L\u012bdzek\u013cu Lieto\u0161anai \u0136irur\u0123iskaj\u0101 Praks\u0113. KS\/MET-011-00. B\u0113rnu Kl\u012bnisk\u0101 Universit\u0101tes Slimn\u012bca. 2019, Available online: https:\/\/www.spkc.gov.lv\/lv\/media\/4147\/download."},{"key":"ref_9","unstructured":"Drugbank Online (2022, June 06). Ceftazidime. Available online: https:\/\/go.drugbank.com\/drugs\/DB00438."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1007\/s10096-022-04452-1","article-title":"Antimicrobial activity of ceftazidime-avibactam and comparators against Pseudomonas aeruginosa and Enterobacterales collected in Croatia, Czech Republic, Hungary, Poland, Latvia and Lithuania: ATLAS Surveillance Program, 2019","volume":"41","author":"Pojnar","year":"2022","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jgar.2019.12.009","article-title":"Resistance to ceftazidime-avibactam and underlying mechanisms","volume":"22","author":"Wang","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_12","unstructured":"University of California San Francisco (2021, July 07). Pediatric Appendicitis Clinical Algorithm. Available online: https:\/\/idmp.ucsf.edu\/content\/pediatric-appendicitis-clinical-algorithm."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.ijid.2021.01.025","article-title":"No significant difference between ceftriaxone and cefotaxime in the emergence of antibiotic resistance in the gut microbiota of hospitalized patients: A pilot study","volume":"104","author":"Pilmis","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e01682-18","DOI":"10.1128\/AAC.01682-18","article-title":"The combination of fosfomycin plus meropenem is synergistic for Pseudomonas aeruginosa PAO1 in a hollow-fiber infection model","volume":"62","author":"Drusano","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"fnx142","DOI":"10.1093\/femsle\/fnx142","article-title":"Optimization of therapy against Pseudomonas aeruginosa with ceftazidime and meropenem using chemostats as model for infections","volume":"364","author":"Feng","year":"2017","journal-title":"FEMS Microbiol. Lett."},{"key":"ref_16","first-page":"9","article-title":"Multidrug-Resistant Pseudomonas aeruginosa Infections: Hard to Treat, But Hope on the Horizon?","volume":"3","author":"Gracia","year":"2018","journal-title":"Contag. Live\u2014Infect. Dis. Today"},{"key":"ref_17","unstructured":"National Center for Biotechnology Information (2019, December 10). PubChem Database. Avibactam, CID=9835049, Available online: https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/Avibactam."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.ijantimicag.2017.01.010","article-title":"A randomised, double-blind, phase 3 study comparing the efficacy and safety of ceftazidime\/avibactam plus metronidazole versus meropenem for complicated intra-abdominal infections in hospitalised adults in Asia","volume":"49","author":"Qin","year":"2017","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.ijantimicag.2016.11.005","article-title":"Clinical experience with ceftazidime\/avibactam in patients with severe infections, including meningitis and lung abscesses, caused by extensively drug-resistant Pseudomonas aeruginosa","volume":"49","author":"Xipell","year":"2017","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e01117-20","DOI":"10.1128\/AAC.01117-20","article-title":"Mechanisms of resistance to ceftolozane\/tazobactam in Pseudomonas aeruginosa: Resultsof the GERPA multicenter study","volume":"65","author":"Fournier","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_21","unstructured":"Medscape (2021, July 07). Piperacillin\/Tazobactam (Rx). Available online: https:\/\/reference.medscape.com\/drug\/zosyn-piperacillin-tazobactam-342485#10."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/j.jpedsurg.2021.03.027","article-title":"Updates on bacterial resistance and empirical antibiotics treatment of complicated acute appendicitis in children","volume":"56","author":"Kwok","year":"2021","journal-title":"J. Pediatr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e20163003","DOI":"10.1542\/peds.2016-3003","article-title":"Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis","volume":"139","author":"Georgiou","year":"2017","journal-title":"Pediatrics"},{"key":"ref_24","unstructured":"National Center for Biotechnology Information (2019, December 12). PubChem Database. Amikacin, CID=37768, Available online: https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/Amikacin."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1047670","DOI":"10.1155\/2018\/1047670","article-title":"In Vitro Antibacterial Interaction of Doripenem and Amikacin against Multidrug-Resistant Acinetobacter Baumannii, Pseudomonas Aeruginosa, and Klebsiella Pneumoniae Isolates","volume":"2018","author":"Loho","year":"2018","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"211","DOI":"10.5811\/cpcem.2018.3.37730","article-title":"Stump Appendicitis","volume":"2","author":"Essenmacher","year":"2018","journal-title":"Clin. Pract. Cases Emerg. Med."},{"key":"ref_27","first-page":"25","article-title":"Acute Appendicitis: Efficient Diagnosis and Management","volume":"98","author":"Snyder","year":"2018","journal-title":"Am. Fam. Physician"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4236\/abb.2018.91001","article-title":"Impact of Some Antibiotics on Bacteria Isolated from Appendices in Kirkuk Province, Iraq","volume":"9","author":"Bazzaz","year":"2018","journal-title":"Adv. Biosci. Biotechnol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1089\/sur.2017.158","article-title":"Antibiotic Use and Antimicrobial Resistance of Surgical Patients with Peritonitis at a Tertiary Referral Hospital in Rwanda","volume":"19","author":"Rickard","year":"2018","journal-title":"Surg. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jgar.2018.09.015","article-title":"Perforated appendicitis in children: Antimicrobial susceptibility and antimicrobial stewardship","volume":"16","author":"Turel","year":"2018","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/sur.2016.261","article-title":"The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection","volume":"18","author":"Mazuski","year":"2017","journal-title":"Surg. Infect."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Jain, N., Jansone, I., Obidenova, T., Simanis, R., Meisters, J., Straupmane, D., and Reinis, A. (2021). Antimicrobial Resistance in Nosocomial Isolates of Gram-Negative Bacteria: Public Health Implications in the Latvian Context. Antibiotics, 10.","DOI":"10.3390\/antibiotics10070791"},{"key":"ref_33","unstructured":"European Committee on Antimicrobial Susceptibility Testing (2022, May 23). Expected Resistant and Susceptible Phenotypes. Available online: https:\/\/www.eucast.org\/expert_rules_and_expected_phenotypes\/expected_phenotypes\/."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1089\/fpd.2018.2523","article-title":"Prevalence and Antimicrobial Resistance of Escherichia coli, Enterococcus spp. and the Major Foodborne Pathogens in Calves in Latvia","volume":"16","author":"Terentjeva","year":"2019","journal-title":"Foodborne Pathog. Dis."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/9\/1144\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:14:03Z","timestamp":1760141643000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/9\/1144"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,23]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["medicina58091144"],"URL":"https:\/\/doi.org\/10.3390\/medicina58091144","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,23]]}}}