ACUTE APPENDICITIS AND THE USE OF INTRAPERITONEAL CULTURES

We reviewed the charts of 200 patients with a preoperative diagnosis o f acute appendicitis (AA) to evaluate the influence and use of intraop erative culture results on patient management and antibiotic selection . Cultures were obtained in 66 percent of patients; 16 percent of the cultures in patients with AA yielded positive results versus 88 percen t of cultures in patients with perforated or gangrenous appendicitis ( complicated appendicitis [CA]) and in nine patients, positive cultures were used to adjust antibiotic therapy. Patients with CA who had anti biotic changes based on culture results had a complication rate of 25 percent versus a 29 percent rate for this group as a whole. We conclud e that intraoperative cultures in patients with AA are rarely positive and do not influence antibiotic therapy or patient management. In CA, antibiotic changes based on culture results do not seem to alter pati ent outcome. Surgeons tend to rely on the proved efficacy of empiric a ntibiotic therapy and other basic surgical principles to afford the be st outcome for their patients. The routine practice of obtaining perit oneal cultures in patients operated upon for AA and CA should be aband oned.