Nguyen B L, Raynor S, Thompson J S
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
Am Surg. 1992 May;58(5):280-3.
Whether prophylactic antibiotics should be employed routinely in all patients with presumed appendicitis rather than be administered selectively to those with suspected perforation remains a controversial issue. The outcome of 312 adult patients undergoing appendectomy during periods of selective (I, n = 153) and routine (II, n = 159) antibiotic use were compared. Although the rates of misdiagnosis were comparable (9% vs 13%), significantly more patients with appendicitis in Period II had perforated appendicitis (29 of 139 vs 44 of 139, P less than 0.05). Prophylactic antibiotics were given to 43 (28%) patients in Period I compared to 132 (83%) in Period II (P less than 0.001). This, increased frequency was true for both simple (21% vs 81%, P less than 0.001) and perforated (66% vs 86%, P less than 0.05) appendicitis. A single antibiotic, most frequently a cephalosporin, was used significantly more often in Period II (44% vs 82%, P less than 0.001). There was no significant difference in the methods of wound closure between the two periods. The incidence of infectious complications was similar in patients with simple appendicitis in both periods (8% vs 11%), but it was significantly greater during Period I in patients with perforated appendicitis (45% vs 20%, P less than 0.05). The overall infection rate was similar in both periods (16% vs 22%). Thus, high-risk patients with perforated appendicitis were more likely to receive antibiotics and had a lower infection rate with routine antibiotic use. Furthermore, there was no overall change in the infection rate during this period, despite the use of less toxic, single drug regimens and a greater percentage of perforated appendicitis.
对于所有疑似阑尾炎患者，预防性抗生素是应常规使用还是仅选择性地给予那些疑似穿孔的患者，这仍然是一个有争议的问题。我们比较了312例接受阑尾切除术的成年患者在选择性（I组，n = 153）和常规（II组，n = 159）使用抗生素期间的结局。尽管误诊率相当（9% 对13%），但II期阑尾炎患者中发生穿孔性阑尾炎的比例显著更高（139例中有29例对139例中有44例，P小于0.05）。I期有43例（28%）患者接受了预防性抗生素治疗，而II期为132例（83%）（P小于0.001）。对于单纯性（21% 对81%，P小于0.001）和穿孔性（66% 对86%，P小于0.05）阑尾炎，这种增加的频率都是如此。II期更频繁地单独使用一种抗生素，最常用的是头孢菌素（44% 对82%，P小于0.001）。两个时期之间伤口闭合方法没有显著差异。两个时期单纯性阑尾炎患者的感染并发症发生率相似（8% 对11%），但I期穿孔性阑尾炎患者的感染并发症发生率显著更高（45% 对20%，P小于0.05）。两个时期的总体感染率相似（16% 对22%）。因此，穿孔性阑尾炎的高危患者更有可能接受抗生素治疗，且常规使用抗生素时感染率较低。此外，尽管使用了毒性较小的单一药物方案且穿孔性阑尾炎的比例更高，但在此期间感染率没有总体变化。
