Increased Disease Severity in Patients Suffering from Appendicitis with Cultures GrowingStrepotoccus anginosus
*Allison R Wilcox1, *Olivia A Sacks2, *Laura E Baumann1, Eleah D Porter1, Daniel P Croitoru1, *Reto M Baertschiger1
1Dartmouth-Hitchcock Medical Center, Lebanon, NH;2Geisel School of Medicine at Dartmouth, Hanover, NH
Objective: Streptococcus anginosus (SA) are a subgroup of normal gut flora with pathogenic propensity toward abscess formation. A recent UK study found increased disease severity in pediatric patients growing SA in the setting of appendicitis. The aim of our study is to evaluate the clinical significance of appendicitis-associated SA in the pediatric population at our institution.
Design: Retrospective cohort.
Setting: Rural, quaternary care center in New England.
Patients: Pediatric patients (≤17) with ICD 9/10 code diagnosed appendicitis and corresponding intra-abdominal or pelvic fluid culture from 10/1/2012-9/30/2017. Patients dichotomized by culture result: SA(+) vs. SA(-).
Intervention: N/A.
Main Outcome Measures: Disease severity within 1-year follow-up, measured by readmission rate, length of stay for all appendicitis-related admissions, duration of antibiotics, and post-appendectomy intra-abdominal or pelvic abscess.
Results: 77 patients met inclusion criteria; 27 patients had SA(+) peritoneal cultures. All patients underwent appendectomy within one year. There was no difference in age or gender between SA(+) and SA(-) patients. SA(+) patients had significantly longer antibiotic duration than SA(-) patients (19.0 vs 13.7 days, respectively; p<0.05). There was also a trend toward higher readmission rate (33% vs 18%, p=0.13) and development of post-appendectomy abscess (22% vs 10%, p=0.14) in SA(+) patients (Table 1).
Conclusions: Although limited by population size, our findings corroborate those seen in the UK study that appendicitis-associated SA is associated with increased disease severity in pediatric patients. To our knowledge, ours are the first documented SA results in pediatric patients with appendicitis in North America. Further study is warranted. 
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