Chan Kin Wai Edwin, Lee Kim Hung, Mou Jennifer Wai Cheung, Cheung Sing Tak, Sihoe Jennifer Dart Yin, Tam Yuk Him
Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
Pediatr Surg Int. 2010 Feb;26(2):157-60. doi: 10.1007/s00383-009-2540-6.
Antibiotic resistance is a global issue especially in developed areas. With the emergence of antibiotic resistant-bacteria, the traditional choice of broad spectrum antibiotics may not be effective in complicated appendicitis. We herein report the bacteriology and antibiotic susceptibility of intra-operative peritoneal culture in children with acute appendicitis in Hong Kong. This may guide us to adjust the choice of antibiotics with evidence.
A retrospective review of all cases of children who underwent laparoscopic appendicectomy from 2003 to 2007 was performed. Data including histology of appendixes, the choice of antibiotics, bacteriology, and antibiotic susceptibility of the intra-operative peritoneal cultures were analyzed.
Over a 5-year period, 250 children were included in this study. 41 children had gangrenous- and 77 had ruptured appendicitis, respectively. Peritoneal swab was taken in 158 children. Common bacteria isolated including E. coli, Streptococcus, and Bacteroides. Ampicillin, cefuroxime, and metronidazole were our choice of antibiotics. 26% of children with gangrenous and 25% with ruptured appendicitis were insensitive to the current regime. Using 3 antibiotics regime by switching cefuroxime to ceftazidime, it covered 77% resistant bacteria. Using 4 antibiotics regime by adding gentamycin, it covered 96% resistant bacteria.
One-fourth of children with gangrenous or ruptured appendicitis were insensitive to the current regime. This study provides evidence-based information on the choice of antibiotics.
抗生素耐药性是一个全球性问题，在发达地区尤为突出。随着抗生素耐药菌的出现，传统的广谱抗生素选择可能对复杂性阑尾炎无效。我们在此报告香港急性阑尾炎患儿术中腹腔培养的细菌学及抗生素敏感性情况。这可能有助于我们有依据地调整抗生素的选择。
对2003年至2007年接受腹腔镜阑尾切除术的所有儿童病例进行回顾性研究。分析包括阑尾组织学、抗生素选择、细菌学以及术中腹腔培养的抗生素敏感性等数据。
在5年期间，本研究纳入了250名儿童。分别有41名儿童患有坏疽性阑尾炎，77名患有穿孔性阑尾炎。158名儿童进行了腹腔拭子采样。分离出的常见细菌包括大肠杆菌、链球菌和拟杆菌。氨苄西林、头孢呋辛和甲硝唑是我们选择的抗生素。26%的坏疽性阑尾炎患儿和25%的穿孔性阑尾炎患儿对当前治疗方案不敏感。将头孢呋辛换为头孢他啶采用三联抗生素方案，可覆盖77%的耐药菌。添加庆大霉素采用四联抗生素方案，可覆盖96%的耐药菌。
四分之一的坏疽性或穿孔性阑尾炎患儿对当前治疗方案不敏感。本研究为抗生素的选择提供了循证信息。
