Incidence, Predictors, and Outcomes of Pseudomonas aeruginosa Associated Acute Appendicitis in Children.

BACKGROUND: Pseudomonas aeruginosa (PSA) is an infectious pathogen associated with acute appendicitis; however, it is not consistently addressed by empirical antibiotic therapy, despite potential complications. OBJECTIVES: To investigate the incidence, predictors, and outcomes of PSA-associated acute appendicitis in children. METHODS: We conducted a retrospective analysis involving pediatric patients who underwent acute appendicitis surgery and had positive peritoneal cultures. Clinical, microbiological, and intraoperative data were extracted from medical records. RESULTS: Among 2523 children with acute appendicitis, 798 (31.6%) underwent peritoneal cultures, revealing 338 positive cases (42.3%), with PSA detected in 77 cases (22.8%). Children with PSA were three times more likely to exhibit high intraoperative grading ≥ 3 (93.4% vs. 76.8%, 95% confidence interval [95%CI] 1.2-8.3, P = 0.023) and nearly four times more likely to have polymicrobial cultures (88.3% vs. 62.1%, 95%CI 1.8-8.0, P < 0.001) than those without PSA in peritoneal cultures. Duration of symptoms did not predict PSA isolation (P = 0.827). Patients with PSA had longer median hospital stays (8 days, interquartile range [IQR] 7-10) than those with other pathogens (7 days, IQR 5-9) (P = 0.004). Antibiotic treatment duration, intensive care unit admission rates, readmission, and mortality were similar between the two groups (P = 0.893, 0.197, 0.760, and 0.761, respectively). CONCLUSIONS: PSA is a common pathogen in children diagnosed with acute appendicitis and positive peritoneal cultures. The likelihood of isolating PSA increases with high-grade intraoperative assessment and in the presence of multiple pathogens in peritoneal cultures, suggests antipseudomonal treatment.

[RECURRENT WANDERING PNEUMONIA AS AN UNUSUAL PRESENTATION OF FOREIGN BODY ASPIRATION].

INTRODUCTION: In cases of recurrent pneumonia that involved both lungs, foreign body aspiration (FBA) requires a high index of suspicion. BACKGROUND: A previously healthy one-year old boy, was admitted to our department, because of right lower lobe pneumonia with a moderate amount of pleural effusion. He was treated with IV Cefuroxime resulting in a good clinical response. Three weeks later, he was referred again due to left lower lobe pneumonia with a mild amount of pleural effusion. Due to two episodes of pneumonia involving two different lungs within a five week period, a suspicion of an underlying immunodeficiency or other systemic disease was raised and a broad investigation revealed no underlying disease. Despite the lack of a history of FBA and the inappropriate clinical presentation (recurrent pneumonia not in the same side), FBA was still highly considered as a potential diagnosis, mainly due to the fact that these two episodes of pneumonia occurred within a short period of time. A flexible bronchoscopy was performed which revealed a FB lodged at the entrance of the left main bronchus, the FB was extracted by rigid bronchoscopy. Since then the child is asymptomatic with no further signs of pneumonia. CONCLUSIONS: FBA should be highly considered in recurrent pneumonia that involves two lungs especially when the episodes of pneumonia occur within a short period of time. DISCUSSION: In cases of recurrent pneumonia that involve both lungs, FBA requires a high index of suspicion. Our assumption in this unusual case was that the FB was stuck in the carina, tilting and obstructing the entry of the right main bronchus leading to right side pneumonia; and in the second episode, later on, tilting to the left side and obstruction to the left main bronchus resulting in left sided pneumonia.