title: T.E.A. Study: three-day ertapenem versus three-day Ampicillin-Sulbactam Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Comparison of operative and non operative management of acute appendicitis. Retraction Note to: Conservative Management of Acute Appendicitis Burden of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins.
abstract: Background Intra-abdominal infections are one of the most common infections encountered by a general surgeon . However , despite this prevalence , st and ardized guidelines outlining the proper use of antibiotic therapy are poorly defined due to a lack of clinical trials investigating the ideal duration of antibiotic treatment . The aim of this study is to compare the efficacy and safety of a three-day treatment regimen of Ampicillin-Sulbactam to that of a three-day regimen of Ertapenem in patients with localized peritonitis ranging from mild to moderate severity . Methods This study is a prospect i ve , multi-center , r and omized investigation performed in the Department of General , Emergency , and Transplant Surgery of St. Orsola-Malpighi University Hospital in Bologna , Italy . Discrete data were analyzed using the Chi-squared and Fisher exact tests . Differences between the two study groups were considered statistically significant for p-values less than 0.05 . Results 71 patients were treated with Ertapenem and 71 patients were treated with Ampicillin-Sulbactam .  The two groups were comparable in terms of age and gender as well as the site of abdominal infection . Post-operative infection was identified in 12 patients : 10 with wound infections and 2 with intra-abdominal infections . In the Ertapenem group , 69 of the 71 patients ( 97 % ) were treated successfully , while the therapy failed in 2 cases ( 3 % ) . Therapy failures were more frequent in the Unasyn group , amounting to 10 of 71 cases ( p = 0.03 ) . Conclusion According to these preliminary findings , the authors conclude that a three-day Ertapenem treatment regimen is the most effective antibiotic therapy for patients with localized intra-abdominal infections ranging from mild to moderate severity . Trial registration Trial registration : Clinical Trials.gov : OBJECTIVE The aim of this study was to evaluate the feasibility and safety of nonoperative treatment of acute nonperforated appendicitis with antibiotics in children . METHODS A pilot r and omized controlled trial was performed comparing nonoperative treatment with antibiotics versus surgery for acute appendicitis in children . Patients with imaging-confirmed acute nonperforated appendicitis who would normally have had emergency appendectomy were r and omized either to treatment with antibiotics or to surgery . Follow-up was for 1 year . RESULTS Fifty patients were enrolled ; 26 were r and omized to surgery and 24 to nonoperative treatment with  antibiotics . All children in the surgery group had histopathologically confirmed acute appendicitis , and there were no significant complications in this group . Two of 24 patients in the nonoperative treatment group had appendectomy within the time of primary antibiotic treatment and 1 patient after 9 months for recurrent acute appendicitis . Another 6 patients have had an appendectomy due to recurrent abdominal pain ( n = 5 ) or parental wish ( n = 1 ) during the follow-up period ; none of these 6 patients had evidence of appendicitis on histopathological examination . CONCLUSIONS Twenty-two of 24 patients ( 92 % ) treated with antibiotics had initial resolution of symptoms . Of these 22 , only 1 patient ( 5 % ) had recurrence of acute appendicitis during follow-up . Overall , 62 % of patients have not had an appendectomy during the follow-up period . This pilot trial suggests that nonoperative treatment of acute appendicitis in children is feasible and safe and that further investigation of nonoperative treatment is warranted BACKGROUND In this prospect i ve study , operative and nonoperative management of acute appendicitis were evaluated regarding their safety and cost effectiveness . METHODS Two hundred ninety patients presenting to our Emergency Department between March 2005 and March 2006 with acute appendicitis were included in this prospect i ve study . Nonoperative medical therapy was performed in 107 patients ( Group 1 ) , and 183 patients were treated surgically ( Group 2 ) . Routine follow-up controls were done on the 10th day , at the 3rd and 6th months and at the first year after discharge in Group 1 . Both groups were compared regarding age , gender , mean hospital stay , modified Alvarado score , morbidity , mortality , and cost effectiveness . RESULTS The male/female ratio of Groups 1 and 2 were 65/42 ( mean age : 30.98+/-1.30 ) and 125/58 ( mean age : 26.25+/-0.79 ) , respectively . In Group 1 , 19 patients were operated . Operation indications were resistance to therapy , patient 's request , and operation in another hospital . Although the mean hospital stay of Group 1 was statistically significantly longer than Group 2 , the mean cost of the therapy was $ 559 in Group 2 and $ 433 in Group 1 . Morbidity rates were similar , with no mortality in either group . CONCLUSION With its high success rate and cost effectiveness , medical treatment seems to be a good alternative to the gold st and ard therapy of surgery in management of acute appendicitis The editors of the Journal of Gastrointestinal Surgery as well as the SSAT Board of Directors have retracted the article Malik , A.A. & Bari , S.U. Conservative management of  acute appendicitis . J Gastrointest . Surg 13 , 966–970 ( 2009 ) since significant portions of the article were published earlier in the following articles : Eriksson , S. & Granstrom , L. R and omized controlled trial of appendectomy versus antibiotic therapy for acute appendicitis . Br J Surg 82 , 166–169 ( 1995 ) . Horton , M.D. , Counter , S.F. , Florence , M.G. & Hart , M.J. A prospect i ve trial of computed tomography and ultrasonography for diagnosing  appendicitis in the atypical patient . Am J Surg 179 , 379–381 ( 2000 ) OBJECTIVES This study determined excess mortality and length of hospital stay ( LOS ) attributable to bloodstream infection ( BSI ) caused by third-generation-cephalosporin-resistant Escherichia coli in Europe . METHODS A prospect i ve parallel matched cohort design was used . Cohort I consisted of patients with third-generation-cephalosporin-resistant E. coli BSI ( REC ) and cohort II consisted of patients with third-generation-cephalosporin-susceptible E. coli BSI ( SEC ) . Patients in both cohorts were matched for LOS before infection with patients free of the respective BSI . Thirteen European tertiary care centres participated between July 2007 and June 2008 . RESULTS Cohort I consisted of 111 REC patients and 204 controls and cohort II consisted of 1110 SEC patients and 2084 controls . REC patients had a higher mortality at 30 days ( adjusted odds ratio = 4.6 ) and a higher hospital mortality ( adjusted hazard ratio = 5.7 ) than their controls . LOS was increased by 8 days . For SEC patients , these figures were adjusted odds ratio = 1.9 , adjusted hazard ratio = 2.0 and excess LOS = 3 days . A 2.5 times [ 95 % confidence interval ( 95 % CI ) 0.9 - 6.8 ] increase in all-cause mortality at 30 days and a 2.9 times ( 95 % CI 1.2 - 6.9 ) increase in mortality during entire hospital stay as well as an excess LOS of 5 days ( 95 % CI 0.4 - 10.2 ) could be attributed to resistance to third-generation cephalosporins in E. coli BSI . CONCLUSIONS Morbidity and mortality attributable to third-generation-cephalosporin-resistant E. coli BSI is significant . If prevailing resistance trends continue , high societal and economic costs can be expected . Better management of infections caused by resistant E. coli is becoming essential
target: With significantly higher efficacy and low complication rates , appendectomy remains the most effective treatment for patients with uncomplicated AA .
background: BACKGROUND Acute appendicitis is the most common surgical diagnosis in young patients , with lifetime prevalence of about 7 % .
  Debate remains on whether uncomplicated AA should be operated or not .
  Aim of this meta- analysis of r and omized controlled trials was to assess current evidence on antibiotic treatment for uncomplicated AA compared to st and ard surgical treatment .