Optimization of the medical management of appendicular abscess and plastron in children: a 2009 to 2019 cohort study

Abstract

Background: In our hospital, children with appendicular plastron or abscess receive a medical treatment with cefotaxime, metronidazole and gentamicin followed by amoxicillin/clavulanic acid as an oral switch. Appendectomy is performed 10 to 12 weeks after the beginning of the discharge. A high failure rate was noticed with a switch to a second line treatments, rehospitalization or an emergency surgery. The objective of our study was to highlight predictive factors for the treatment response. Methods: We conducted a retrospective monocentric study between 2009 and 2019. Inclusion criteria were children under 16 years old diagnosed with appendicular plastron or abscess, treated with a medical treatment. We divided the cohort into a success and a failure group and compared their demographic data, clinical symptoms, inflammatory markers, abdominal imaging and antibiotic regimen. Results: Seventy-four patients were enrolled in the study and the failure rate was 36% (n=27). The median age in the success group was 8.7 years old (2-14) and 9.4 years old (2-15) in the failure group. Multiple abscesses (6.5% versus 32%, p=0.02) and diarrhea at admission (19% versus 44%, p=0.02) were significantly associated with a failure. Palpable mass (47% versus 67%, p=0.09) and stercoliths (34% versus 52%, p=0.13) appeared to be more important in the failure group. Discussion and conclusion: Several factors were analyzed to predict the response to the medical treatment for children with appendicular abscess or plastron. Patients with multiple abscesses will no longer be treated with antibiotics. We also recommended greater vigilance after detecting stercoliths in the medical imaging based on other studies results. Time to hospitalization, time to apyrexia, CRP and white blood cells level at admission were not different between the success and the failure group. Finally, a wider bacterial epidemiology study is needed in order to adjust our local guidelines and the antibiotic therapy.