Assistance Publique-Hôpitaux de Paris, Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, Paris 75015, France.
Diagn Microbiol Infect Dis. 2011 Apr;69(4):376-81. doi: 10.1016/j.diagmicrobio.2010.11.003.
Preoperative samples in the context of complicated appendicitis (CA) are rarely collected, and there is no consensus regarding the optimal antibiotic therapy in children. To help optimize empirical preoperative treatment, we studied clinical and bacteriologic data from a prospective cohort of 93 children with CA in a French hospital. All the bacteria isolated from peritoneal fluids were identified, using phenotypic and/or molecular techniques. The most commonly recovered species were Escherichia coli (71%), Streptococcus group milleri (34%), anaerobes (20%), and Pseudomonas aeruginosa (19%). The association piperacillin-tazobactam is an accurate choice of empirical therapy as it is active against 97% of bacteria. A third-generation cephalosporin with metronidazole in association with an aminoglycoside is a good alternative. Although antibiotic use may be considered as an adjunct to surgical intervention of CA, the appropriate use of preoperative antibiotics is essential and must be constantly reevaluated according to the bacterial epidemiology.
术前样本在复杂阑尾炎（CA）的情况下很少收集，并且对于儿童的最佳抗生素治疗也没有共识。为了帮助优化经验性术前治疗，我们研究了法国医院前瞻性队列中 93 例 CA 患儿的临床和细菌学数据。使用表型和/或分子技术鉴定从腹腔液中分离出的所有细菌。最常回收的物种是大肠杆菌（71%）、米勒链球菌组（34%）、厌氧菌（20%）和铜绿假单胞菌（19%）。哌拉西林-他唑巴坦联合治疗是经验性治疗的准确选择，因为它对 97%的细菌有效。与氨基糖苷类药物联合使用的第三代头孢菌素是一个很好的替代品。尽管抗生素的使用可以被认为是 CA 手术干预的辅助手段，但术前抗生素的合理使用是必不可少的，并且必须根据细菌流行病学不断重新评估。
