The impact of bloodstream infection in patients undergoing appendectomy due to acute appendicitis

Abstract

Introduction: Current severity classification of appendicitis does not take into account the impact of bloodstream infection (BSI), despite the importance of BSI in critical care settings. Therefore, we examined whether BSI in emergency appendectomy indicated for acute appendicitis has a clinical impact. Methods: We retrospectively reviewed patients with acute appendicitis who underwent emergency surgery at our department between July 2015 and January 2020. Results: BSI was detected in 14 out of 154 patients (9%). Patients with BSI had a higher rate of major complications, readmission rate, and longer postoperative hospital stay, but there was no difference in the rate of complicated and uncomplicated appendicitis. Multivariate analysis showed age ≧ 58 years (Odds ratio [OR] 8.98 95% Confidence interval [CI] 2.07–39.0) and bilirubin ≧ 2.0 mg/dl (OR 8.79 95% CI 1.09–71.0) were associated with BSI. In 4 out of 8 cases (50%), the bacteria isolated in patients with BSI were not isolated in patients with intraabdominal infection (IAI). Conclusion: BSI in acute appendicitis had a clinical impact on postoperative outcomes, irrespective of complicated and uncomplicated appendicitis. Blood cultures should be considered for older patients, and patients with high bilirubin levels in emergency appendectomy for acute appendicitis.