Boueil Alexia, Guégan Hervé, Colot Julien, D'Ortenzio Eric, Guerrier Gilles
Department of General and Abdominal Surgery, Centre Hospitalier Territorial, Noumea, New Caledonia.
Laboratory of Microbiology, Institut Pasteur in New Caledonia, Noumea, New Caledonia.
Asian J Surg. 2015 Oct;38(4):242-6. doi: 10.1016/j.asjsur.2015.03.005. Epub 2015 May 2.
Little data on the usefulness of microbiological samples in appendicular peritonitis (AP) are available. The objectives of the study were to document the clinical value of systematic peritoneal swabbing in complicated appendicitis, to establish whether they influence postoperative outcome, and to help to optimize empirical preoperative treatment.
Charts of all consecutive patients undergoing appendicectomy for acute perforated appendicitis were analyzed over a 7-year period from 2005 to 2011 in a tertiary hospital in New Caledonia. From prospectively recorded data, microbiological culture results, and sensitivity of isolates were obtained in relation to histopathological findings and infective morbidity.
Overall, 144 cases including 47 (33%) children and 97 (67%) adults with perforated appendicitis were included in the study. Fifty-one (35%) had generalized peritonitis treated laparoscopically in 30 (59%) cases. Peritoneal fluid samples yielded a positive culture in 104 (74%) patients. The most commonly recovered species were Escherichia coli (81%), Streptococcus milleri group (12%), and Pseudomonas aeruginosa (12%). Postoperative infectious complications occurred in 32 (22%) including intra-abdominal abscess (n = 20) and wound infection (n = 12). Probabilist antibiotic regimen was less often suitable in children than in adults (p = 0.003). Infectious complications occurred more often in cases with an unsuitable antibiotic regimen after culture results compared with a suitable antibiotic regimen before culture results (p = 0.01).
Although antibiotic use may be considered as an adjunct to surgical intervention of AP, the appropriate use of preoperative antibiotics and modifications according to culture results are essential to prevent infectious complications.
关于微生物样本在阑尾周围炎（AP）中的作用的数据很少。本研究的目的是记录系统性腹膜拭子检查在复杂性阑尾炎中的临床价值，确定其是否影响术后结局，并有助于优化术前经验性治疗。
对2005年至2011年在新喀里多尼亚一家三级医院接受急性穿孔性阑尾炎阑尾切除术的所有连续患者的病历进行分析。从前瞻性记录的数据中，获得了与组织病理学结果和感染性发病率相关的微生物培养结果及分离株的敏感性。
本研究共纳入144例患者，其中包括47例（33%）儿童和97例（67%）成人穿孔性阑尾炎患者。51例（35%）发生弥漫性腹膜炎，其中30例（59%）接受了腹腔镜治疗。104例（74%）患者的腹膜液样本培养呈阳性。最常见的分离菌种为大肠埃希菌（81%）、米勒链球菌组（12%）和铜绿假单胞菌（12%）。32例（22%）发生术后感染并发症，包括腹腔内脓肿（n = 20）和伤口感染（n = 12）。概率性抗生素治疗方案在儿童中比在成人中更不常用（p = 0.003）。与培养结果前使用合适抗生素治疗方案相比，培养结果后使用不合适抗生素治疗方案的患者感染并发症发生率更高（p = 0.01）。
虽然抗生素的使用可被视为AP手术干预的辅助手段，但术前抗生素的合理使用以及根据培养结果进行调整对于预防感染并发症至关重要。
