Background
Methods
Aim
Study design
Inclusion criteria
Statistical analysis
Results
Patients and diagnosis
Clinical and laboratory findings | Patients N = 4282 (100%) |
---|---|
Diffuse tenderness | 502 (11.7%) |
Right lower quadrant pain | 3906 (91.2%) |
Right lower quadrant tenderness | 2980 (69.6%) |
Vomiting | 1798 (42.0%) |
Temperature > 38 °C | 1057 (24.7%) |
WBC > 10,000/ml | 3494 (81.6%) |
CRP < 10 mg/l | 848 (19.8%) |
CRP 10–50 mg/l | 1097 (25.6%) |
CRP > 50 mg/l | 876 (20.5%) |
CRP not reported | 1461 (34.1%) |
Management
Patients receiving antibiotics | N = 3463 (%) |
---|---|
Metronidazole or ornidazole | 2021 (58.2%) |
Third-generation cephalosporins | 1280 (37.0%) |
Second-generation cephalosporins | 598 (17.2%) |
Penicillins + beta lactams-inhibitors | 500 (14.4%) |
First-generation cephalosporins | 437 (12.6%) |
Second-generation quinolones | 304 (8.8%) |
Aminoglycosides | 289 (8.3%) |
Ureidopenicillins + beta lactams-inhibitors | 130 (3.7%) |
Aminopenicillins | 61 (1.8%) |
Carbapenems | 58 (1.7%) |
Third-generation cephalosporins + beta lactams-inhibitors | 52 (1.5%) |
Third-generation quinolones | 18 (0.5%) |
Fourth-generation cephalosporins | 12 (0.3%) |
Others | 15 (0.4%) |
Total | N = 275 |
---|---|
Aerobic gram-negative bacteria | |
Escherichia coli | 159 (57.8%) |
Klebsiella pneumoniae | 19 (6.9%) |
Klebsiella oxytoca | 4 (1.5%) |
Enterobacter spp. | 5 (1.8%) |
Proteus spp. | 1 (0.4%) |
Pseudomonas aeruginosa | 5 (1.8%) |
Aerobic gram-positive bacteria | |
Enterococcus faecalis | 42 (15.3%) |
Streptococci spp. | 24 (8.7%) |
Enterococcus faecium | 11 (4.0%) |
Staphylococcus aureus | 6 (2.2%) |
Others | 7 (2.5%) |
Anaerobic bacteria | |
Bacteroides spp. | 105 (38.2%) |
Clostridium spp. | 4 (1.5%) |
Outcome
Variables | Patients N = 4282 (%) | Dead N = 12 (%) | Survivors N = 4270 (%) | RR (CI 95%) | p value |
---|---|---|---|---|---|
Age > 80 years | 52 (1.2) | 2 (16.7) | 50 (1.2) | 14.23 (3.90–51.96) | < 0.05 |
Immunosuppression | 71 (1.7) | 3 (25.0) | 68 (1.6) | 15.70 (5.73–43.01) | < 0.001 |
Severe cardiovascular disease | 154 (3.6) | 3 (25.0) | 151 (3.5) | 7.07 (2.62–19.07) | < 0.05 |
Charlson Comorbidity Score > 5 | 23 (0.5) | 4 (33.3) | 19 (0.4) | 74.91 (29.93–187.48) | < 0.001 |
Previous episodes suspected app. | 427 (10.0) | 2 (16.7) | 425 (10.0) | 1.67 (0.47–5.95) | 0.33 |
Previous antimicrobial therapy | 327 (7.6) | 4 (33.3) | 323 (7.6) | 4.40 (1.97–9.87) | < 0.05 |
WBC > 10,000/ml | 3434 (80.2) | 10 (83.3) | 3424 (80.2) | 1.04 (0.81–1.33) | 1.00 |
CRP > 50 mg/l | 876 (20.5) | 5 (41.7) | 871 (20.4) | 2.04 (1.04–4.00) | 0.08 |
WSES Grading System | |||||
Grade 0 | 145 (3.4) | 0 | 144 (3.4) | 0 | 1.00 |
Stage 1 | 1896 (44.3) | 3 (25.0) | 1893 (44.3) | 0.56 (0.21–1.50) | 0.18a |
Stage 2a | 632 (14.8) | 0 | 632 (14.8) | 0 | 0.23 |
Stage 2b | 129 (3.0) | 1 (8.3) | 128 (3.0) | 2.78 (0.42–18.29) | 0.31 |
Stage 3a | 332 (7.8) | 0 | 332 (7.8) | 0 | 0.62 |
Stage 3b | 181 (4.2) | 0 | 181 (4.2) | 0 | 1.00 |
Stage 3c | 73 (1.7) | 2 (16.7) | 71 (1.7) | 10.02 (2.77–36.27) | < 0.05 |
Stage 4 | 376 (8.8) | 6 (50.0) | 370 (8.7) | 5.75 (3.24–10.22) | < 0.001 |
Not reported | 517 (12.1) | 0 | 517 (12.1) | NA | NA |
Pathology | |||||
Normal | 144 (3.4) | 0 | 144 (3.4) | 0 | 1.00 |
Inflammation | 1147 (26.8) | 2 (16.7) | 1145 (26.8) | 0.62 (0.17–2.20) | 0.53 |
Periappendicitis | 236 (5.5) | 1 (8.3) | 235 (5.5) | 1.51 (0.23–9.92) | 0.49 |
Suppurative | 1176 (27.5) | 2 (16.7) | 1174 (27.5) | 0.61 (0.17–2.15) | 0.53 |
Gangrenous | 673 (15.7) | 2 (16.7) | 671 (15.7) | 1.06 (0.30–3.76) | 1.00 |
Perforation | 256 (6.0) | 4 (33.3) | 252 (5.9) | 5.65 (2.51–12.68) | < 0.05 |
Not reported | 650 (15.2) | 1 (8.3) | 650 (15.2) | NA | NA |
Variables | OR | 95% CI | p value |
---|---|---|---|
Age > 80 | 4.54 | 0.59–35.20 | 0.15 |
Immunosuppression | 1.17 | 0.11–12.63 | 0.90 |
Severe cardiovascular disease | 1.51 | 0.25–9.08 | 0.65 |
Charlson Comorbidity Score > 5 | 52.45 | 5.95–462.03 | < 0.05 |
Previous antimicrobial therapy | 2.29 | 0.48–10.85 | 0.30 |
WSES Grading System | |||
Stage 3c | 11.77 | 1.37–100.78 | < 0.05 |
Stage 4 | 11.32 | 2.18–58.62 | < 0.05 |
Pathology | |||
Perforation | 1.43 | 0.28–7.24 | 0.66 |