Dr. Moodu Vamshi Kiran is an MS General Surgery postgraduate trainee at S.V.S. Medical College and Hospital, Mahabubnagar, Telangana, India. He completed his MBBS from Kamineni Institute of Medical Sciences in 2021. His clinical and research interests include general surgery, gastrointestinal surgery, emergency surgery, surgical infections, and evidence-based surgical practice. His research focuses on the microbiological profile and antimicrobial susceptibility patterns of complicated and uncomplicated acute appendicitis.

Title: Microbiological Profile and Antibiotic Resistance Patterns in Complicated versus Uncomplicated Acute Appendicitis: A Prospective Cohort Study from a Tertiary Care Center

Abstract: Microbiological Profile and Antibiotic Resistance Patterns in Complicated Versus Uncomplicated Acute Appendicitis: A Prospective Cohort Study

Background: Acute appendicitis is a common surgical emergency, with complicated cases associated with increased morbidity and prolonged hospitalization. Understanding the microbiological profile and antibiotic resistance patterns is important for appropriate antimicrobial therapy. Regional data from South India, particularly Telangana, remain limited.

Methods: A prospective cohort study was conducted at S.V.S. Medical College and Hospital, Telangana, from March 2024 to February 2026. A total of 100 patients with acute appendicitis were included and classified into uncomplicated acute appendicitis (UAA) and complicated acute appendicitis (CAA). Intraoperative appendicular or peritoneal samples were collected for microbiological analysis and antibiotic susceptibility testing. Clinical characteristics and postoperative outcomes were compared between the two groups.

Results: Of the 100 patients, 60% had UAA and 40% had CAA. The mean age was significantly higher in patients with CAA than UAA (50.33±7.2 vs. 31.82±7.46 years; p<0.001). Culture positivity was 100% in CAA compared with 50% in UAA. Polymicrobial infections were observed predominantly in CAA, with anaerobic organisms frequently identified. Escherichia coli was among the common organisms isolated. High antibiotic resistance was observed against meropenem (34%), amoxicillin (31%), and ceftriaxone (30%). Surgical-site infection occurred in 25% of CAA patients compared with none in the UAA group, while mean hospital stay was longer in CAA (7.25 vs. 2.77 days).

Conclusion: Complicated acute appendicitis demonstrates greater microbial diversity, increased polymicrobial infection, and higher antibiotic resistance compared with uncomplicated appendicitis. Local microbiological surveillance and institution-specific antibiograms may help guide appropriate empirical antibiotic therapy and improve postoperative outcomes.

Keywords: Acute appendicitis; Complicated appendicitis; Microbiology; Antibiotic resistance; Escherichia coli; Polymicrobial infection.