Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1175-1181
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1175
Post-appendectomy pelvic abscess with extended-spectrum beta-lactamase producing Escherichia coli: A case report and review of literature
Andrew Tse, Rajkumar Cheluvappa, Selwyn Selvendran
Andrew Tse, Selwyn Selvendran, Department of Surgery, St George Public Hospital, Kogarah NSW 2217, Australia
Andrew Tse, Selwyn Selvendran, St George and Sutherland Clinical School, University of New South Wales, Sydney NSW 2052, Australia
Rajkumar Cheluvappa, BN Program, Discipline of Nursing and Midwifery, University of Canberra, Bruce ACT 2617, Australia
Author contributions: Tse A and Cheluvappa R performed research and wrote this paper; Cheluvappa R addressed reviewers’ comments and did the final submission; Selvendran S designed research and supervised the writing of this paper.
Informed consent statement: Informed consent was obtained from the patient, and appropriate signed documentation was obtained and retained.
Conflict-of-interest statement: The authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Selwyn Selvendran, BSc (Hons), MBChB, MRCS (Edin), FRACS, Consultant, General and Trauma Surgeon, St George Hospital, Kogarah, NSW 2217, Australia. tselvendran@hotmail.com
Telephone: +61-414-138157
Received: October 19, 2018
Peer-review started: October 19, 2018
First decision: November 12, 2018
Revised: November 11, 2018
Accepted: November 14, 2018
Article in press: November 15, 2018
Published online: December 26, 2018
Processing time: 66 Days and 18.7 Hours
Abstract
BACKGROUND

Appendicitis, the inflammation of the appendix, is the most common abdominal surgical emergency requiring expedient surgical intervention. Extended-spectrum beta-lactamases (ESBLs) are bacterial enzymes that catalyse the degradation of the beta-lactam ring of penicillins and cephalosporins (but without carbapenemase activity), leading to resistance of these bacteria to beta-lactam antibiotics. Recent increases in incidence of ESBL-producing bacteria have caused alarm worldwide. Proportion estimates of ESBL-Enterobacteriaceae hover around 46% in China, 42% in East Africa, 12% in Germany, and 8% in the United States.

CASE SUMMARY

The impact of ESBL-producing bacteria on appendiceal abscesses and consequent pelvic abscesses are yet to be examined in depth. A literature review using the search words “appendiceal abscesses” and “ESBL Escherichia coli (E. coli)” revealed very few cases involving ESBL E. coli in any capacity in the context of appendiceal abscesses. This report describes the clinical aspects of a patient with appendicitis who developed a postoperative pelvic abscess infected with ESBL-producing E. coli. In this report, we discuss the risk factors for contracting ESBL E. coli infection in appendicitis and post-appendectomy pelvis abscesses. We also discuss our management approach for post-appendectomy ESBL E. coli pelvic abscesses, including drainage, pathogen identification, and pathogen characterisation. When ESBL E. coli is confirmed, carbapenem antibiotics should be promptly administered, as was done efficaciously with this patient. Our report is the first one in a developed country involving ESBL E. coli related surgical complications in association with a routine laparoscopic appendectomy.

CONCLUSION

Our report is the first involving ESBL E. coli and appendiceal abscesses, and that too consequent to laparoscopic appendectomy.

Keywords: Appendectomy; Appendiceal abscess; Appendicitis; Beta-Lactam; Antibiotic resistance; Beta-Lactamase; Carbanepem; Cephalosporin; Escherichia coli; Extended-spectrum beta-lactamase; Infection; Pelvic abscess; Penicillin; Case report

Core tip: This report describes the clinical aspects of a patient with appendicitis who developed a postoperative pelvic abscess infected with extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli). Our report is the first reliable report involving ESBL E. coli and appendiceal abscesses. This report is also the first one in a developed country involving ESBL E. coli related surgical complications in association with a routine laparoscopic appendectomy.