Does the Covid-19 pandemic have an effect on wound culture in patients undergoing appendectomy? A Case Control Study

Year 2022, , 332 - 338, 15.03.2022

Hacı Bolat , Tuğba Avan Mutlu

https://doi.org/10.16899/jcm.1075112

Abstract

Aim: The aim of this study is to examine the effect of the changing microbiota structure during the pandemic period on the bacterial aerobic culture profile of the wound taken from patients operated for acute appendicitis, together with clinical variables.
Materials and Methods: Our study included 125 patients who underwent an appendectomy in the General Surgery Clinic between 01.03.2019-01.02.2021 and whose wound culture was taken during an appendectomy. The patients were divided into two groups; group1 (pre-pandemic) and group2 (during a pandemic). Both groups were compared in terms of age, gender, clinical, laboratory and wound culture data.
Results: There was no significant difference between the groups in terms of age, clinical symptoms, surgical method, laboratory and radiological data (p>0.05). In the pre-pandemic group, there was growth of E. coli in 35 (53%) patients, K. pneumoniae in 3 (4.5%) patients, and P. aeruginosae in 2 (3) patients from Gram-negative bacteria while Strep. anginosus and Strep. constellatus growth were most common from Gram-positive bacteria. In the pandemic group, there was the growth of E. coli in 29 (49.2%) patients, P. aeruginosae in 5 (8.5%) patients, K. pneumoniae in 2 (3.4%) patients from Gram-negative bacteria, Citrobacterfreundii and Streptococcusanginosus growth were the most common from Gram-positive bacteria. Escherichiacoli is the most common bacteria in both groups.
Conclusion: Although E. coli was found to be the most frequently identified microorganism in patients with acute appendicitis, an increase in the density and resistance of Pseudomonas group bacteria were detected, possibly due to the effect of the COVID-19 pandemic.

Keywords

appendectomy, COVID-19 pandemic, wound culture, antibiotic resistance

Covid-19 Pandemisinin Apendektomi Yapılan Hastalarda Yara Yeri Kültürüne Etkisi Var Mı? Vaka Kontrol Çalışması

Abstract

Amaç: Yaptığımız bu çalışmada amaçpandemi döneminde değişen mikrobiyota yapısının akut apandisit nedeni ile opere edilen hastalardan alınan yara yeri bakteriyel aerobik kültür profilineolan etkisini klinik değişkenlerle birlikte incelemektir.
Gereç ve Yöntem: Çalışmamıza 01.03.2019-01.02.2021 tarihleri arasında Genel Cerrahi Kliniğinde apendektomi yapılan ve apendektomi esnasında yara yeri kültürü alınan 125 hasta dahil edildi. Hastalar iki gruba ayrıldı; grup1(pandemi öncesi) ve grup2 (pandemi süreci). Her iki grup; yaş, cinsiyet, klinik, laboratuvar ve yara yeri kültür verileri açısından karşılaştırıldı.
Bulgular: Gruplar arasında yaş, klinik semptomlar, ameliyat yöntemi, laboratuvar ve radyolojik verileriler açısından anlamlı fark yoktu(p>0,05). Pandemi sürecindeki grupta perfora apendisit, apendokolit, hastanede kalış ve antibiyotik kullanım süresi daha fazla oduğu tespit edildi(p<0,05). Pandemi öncesinde Gram negatif bakterilerden 35 (%53) hastada E. coli, 3 (%4,5) hastada K. pneumoniae, 2 (3) hastada P. aeruginosae üremesi olurken Gram pozitif bakterilerden en çok Strep.anginosusveStrep.constellatusüremesiolmuştur. Pandemidönemindeise Gram negative bakterilerden 29 (%49,2) hastada E. coli, 5 (%8,5) hastada P. aeruginosae, 2 (%3,4) hastada K. pneumoniae üremesi olurken Gram pozitif bakterilerden en çok CitrobacterfreundiiveStreptococcusanginosusüremesiolmuştur. Her ikigrupta da enyaygınüreyenbakteriEscherichiacoli ‘dir.
Sonuç:Akut apandisitli hastalarda en sık tanımlanan mikroorganizma E. coli olarak bulunmuş olsa da muhtemel olarak COVID-19 pandemi sürecinin etkisi ile Pseudomonas gurubu bakterilerin yoğunluğunda ve direnç durumunda artış tespit edilmiştir.

Keywords

COVID-19 Pandemisi, apandektomi, yara yeri kültürü, antibiyotik direnci

References

• 1. Ielpo B, Podda M, Pellino G, Pata F, Caruso R, Gravante G, et al. Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study. The British journal of surgery 2020.
• 2. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 2020;55(3):105924.
• 3. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet2020;395(10224):565-574.
• 4. Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal-oral transmission of SARS-CoV-2 possible?. Lancet Gastroenterol Hepatol 2020;5(4):335-337.
• 5. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China [published correction appears in JAMA 2021; 323(11):1061-1069.
• 6. Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther 2020; 51(9):843-851.
• 7. Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician2018; 98(1):25-33.
• 8. Larner AJ. The aetiology of appendicitis. Br J Hosp Med 1988;39(6):540-542.
• 9. Eddama MMR, Fragkos KC, Renshaw S, Aldridge M, Bough G, Bonthala L, et al. Logistic regression model to predict acute uncomplicated and complicated appendicitis. Ann R Coll Surg Engl 2019; 101(2):107-118.
• 10. Jiménez A, Sánchez A, Rey A, Fajardo C. Recovery of aerobic and anaerobic bacteria from patients with acute appendicitis using blood culture bottles. Recuperación de bacterias aerobias y anaerobias de pacientes con apendicitis aguda mediante botellas de hemocultivo. Biomedica 2019;39(4):699-706.
• 11. Son JT, Lee GC, Kim HO, Kim T, Lee D, Lee SR, et al. Routine Intraoperative Bacterial Culture May Be Needed in Complicated Appendicitis. Ann Coloproctol 2020;36(3):155-162.
• 12. Jackson HT, Mongodin EF, Davenport KP, Fraser CM, Sandler AD, Zeichner SL. Culture-independent evaluation of the appendix and rectum microbiomes in children with and without appendicitis. PLoS One 2014 9(4):e95414.
• 13. Kaźmierczak-Siedlecka K, Vitale E, Makarewicz W. COVID-19 - gastrointestinal and gut microbiota-related aspects. Eur Rev Med Pharmacol Sci 2020;24(20):10853-10859.
• 14. EuropeanCommittee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoints tables for interpretation of MIC sandzonediameters,. Breakpoints tables for interpretation of MIC sandzonediameters, p. Version 7.1. http://www.eucast.org (2021)).2021
• 15. Ley RE, Peterson DA, Gordon JI. Ecological and evolutionary forces shaping microbial diversity in the human intestine. Cell2006;124(4):837-848.
• 16. Chow J, Lee SM, Shen Y, Khosravi A, Mazmanian SK. Host-bacterial symbiosis in health and disease. Adv Immunol 2010;107:243-274.
• 17. Tamboli CP, Neut C, Desreumaux P, Calambel JF. Dysbiosis as a prerequisite for IBD. Gut 2004;53(7):1057. 18. Larsen N, Vogensen FK, Van Den Berg FWJ, Nielsen DS, Andreasen AS, Pedersen BK, et al. Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults. PLoS One 2010; 5(2):e9085.
• 19. Sobhani I, Tap J, Roudot-Thoraval F, Roperch JP, Letulle S, Langella P, et al. Microbial dysbiosis in colorectal cancer (CRC) patients. PLoS One2011; 6(1):e16393.
• 20. Eckburg PB, Bik EM, Bernstein CN, Purdom E, Dethlefsen L, Sargent M, et al. Diversity of the human intestinal microbial flora. Science 2005;308(5728):1635-1638.
• 21. Marsland BJ, Trompette A, Gollwitzer ES. The Gut-Lung Axis in Respiratory Disease. Ann Am Thorac Soc2015; 12 ;2:150-156.
• 22. Mazzarelli A, Giancola ML, Farina A, Marchioni L, Rueca M, Gruber CEM, et al. 16S rRNA gene sequencing of rectal swab in patients affected by COVID-19. PLoS One 2021;16(2):e0247041.
• 23. Kariyawasam JC, Jayarajah U, Riza R, Abeysuriya V, Seneviratne SL. Gastrointestinal manifestations in COVID-19. Trans R Soc Trop Med Hyg 2021;trab042.
• 24. Zuo T, Liu Q, Zhang F, Lui GCY, Tso EYK, Yeoh YK, et al. Depicting SARS-CoV-2 faecal viral activity in association with gut microbiota composition in patients with COVID-19. Gut 2021; 70(2):276-284.
• 25. Li W, Moore MJ, Vasllieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003; 426(6965):450-454.
• 26. Lamps LW. Infectious causes of appendicitis. Infect Dis Clin North Am 2010;24(4):995-x.
• 27. Reinisch A, Malkomes P, Habbe N, Bechstein WO, Liese J. Bad bacteria in acute appendicitis: rare but relevant. Int J Colorectal Dis 2017;32(9):1303-1311.
• 28. Vanhatalo S, Munukka E, Sippola S, Jalkanen S, Grönroos J, Marttila H, et al. Prospective multicentre cohort trial on acute appendicitis and microbiota, aetiology and effects of antimicrobial treatment: study protocol for the MAPPAC (Microbiology APPendicitis ACuta) trial. BMJ Open 2019;9(9):e031137.
• 29. Peeters T, Penders J, Smeekens SP, Galazzo G, Houben B, Netea MG, et al. The fecal and mucosal microbiome in acute appendicitis patients: an observational study. Future Microbiol 2019;14:111-127.
• 30. Arlt A, Bharti R, Ilves I, Häsler R, Miettinen P, Paajanen H, et al. Characteristic changes in microbial community composition and expression of innate immune genes in acute appendicitis. Innate Immun 2015;21(1):30-41.
• 31. Qu J, Cai Z, Liu Y, Duan X, Han S, Liu J, et al. Persistent Bacterial Coinfection of a COVID-19 Patient Caused by a Genetically Adapted Pseudomonas aeruginosa Chronic Colonizer. Front Cell Infect Microbiol 2021;11:641920.
• 32. Defez C, Fabbro-Peray P, Bouziges N, Gouby A, Mahamat A, Daurès JP, et al. Risk factors for multidrug-resistant Pseudomonas aeruginosa nosocomial infection. J Hosp Infect 2004;57(3):209-216.
• 33. Orthopoulos G, Santone E, Izzo F, Tirabassi M, Pérez-Caraballo AM, Corriveau N, et al.Increasing incidence of complicated appendicitis during COVID-19 pandemic. Am J Surg 2021;221(5):1056-1060.
• 34. Gerall CD, DeFazio JR, Kahan AM, Fan W, Fallon EM, Middlesworth W, et al. Delayed presentation and sub-optimal outcomes of pediatric patients with acute appendicitis during the COVID-19 pandemic. J Pediatr Surg 2021;56(5):905-
• 35. Meriç S, Vartanoglu Aktokmakyan T, Tokocin M, Aktimur YE, Hacım NA, Gülcicek OB. Comparative analysis of the management of acute appendicitis between the normal period and COVID-19 pandemic. Ulus Travma Acil Cerrahi Derg. 2021;27(1):22-25.
• 36. Chen CY, Chen YC, Pu HN, Tsai CH, Chen WT, Lin CH. Bacteriology of acute appendicitis and its implication for the use of prophylactic antibiotics. Surg Infect (Larchmt) 2012;13(6):383-390.
• 37. Jeon HG, Ju HU, Kim GY, Jeong J, Kim MH, Jun JB. Bacteriology and changes in antibiotic susceptibility in adults with community-acquired perforated appendicitis. PLoS One 2014;9(10):e111144.
• 38. Sippola S, Haijanen J, Viinikainen L, Grönroos J, Paajanen H, Rautio T, et al. Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis: A Secondary Analysis of a Randomized Clinical Trial. JAMA Surg 2020;155(4):283-289.
• 39. Gorter RR, Eker HH, Gorter-Stam MAW, Abis GSA, Acharya A, Ankersmit M, et al. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc 2016;30(11):4668-4690.
• 40. Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 2016;11:34.
• 41. Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev 2001;2:CD001439.
• 42. Bratzler DW, Houck PM. Surgical Infection Prevention Guidelines Writers Workgroup; Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004;38(12):1706-1715.
• 43. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJC, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt) 2010;11(1):79-109.