Purpose: Consensus is lacking regarding the optimal antibiotic treatment for pediatric complicated appendicitis. This study determined the optimal first-line antibiotic treatment for pediatric patients with complicated appendicitis based on peritoneal fluid cultures. Methods: This retrospective study examined the cases of pediatric patients who underwent appendectomy for complicated appendicitis at our institution between 2013 and 2019. Peritoneal fluid specimens obtained during appendectomy were cultured for the presence of bacteria. Results: Eighty-six pediatric patients were diagnosed with complicated appendicitis.Of them, bacteria were identified in 54 peritoneal fluid samples. The major identified bacteria were Escherichia coli (n=36 [66.7%]), Bacteroides fragilis (n=28 [51.9%]), α-Streptococcus (n=25 [46.3%]), Pseudomonas aeruginosa (n=10 [18.5%]), Enterococcus avium (n=9 [16.7%]), γ-Streptococcus (n=9 [16.7%]), and Klebsiella oxytoca (n=6 [11.1%]). An antibiotic susceptibility analysis showed E. coli was inhibited by sulbactam/ampicillin in 43.8% of cases versus cefmetazole in 100% of cases. Tazobactam/piperacillin and meropenem inhibited the growth of 96.9-100% of the major identified bacteria. E. coli (100% vs. 84.6%) and P. aeruginosa (100% vs. 80.0%) were more susceptible to amikacin than gentamicin. Conclusion Tazobactam/piperacillin or meropenem is a reasonable first-line antibiotic treatment for pediatric complicated appendicitis. In the case of aminoglycoside use, amikacin is recommended.

Purpose: To clarify the relationship between cancer pain self-management and pain in outpatients with advanced cancer taking opioid analgesics. Methods: 56 patients were surveyed using a questionnaire, which included items on cancer pain self-management deductively extracted from previous studies and items from the Japanese version of the Brief Pain Inventory. Results: Among patients self-managing their cancer pain, scores for “facilitation of around-the-clock opioid analgesics compliance” were significantly lower than scores for “interference with life”. Scores for “enduring end-of-dose failure pain” were significantly higher than scores for “severe pain”, “average pain”, and “interference with life”. Scores for “use of rescue doses when pain occurs” were significantly higher than scores for “sleep”. Scores for “methods to relieve pain other than analgesics” were significantly higher than scores for “mood”. Conclusions: The present study suggested that pain relief should be based on the use of opioid analgesics, and indicated the importance in pain relief of pain treatment that ensures good sleep and support for achieving self-management including holistic care.