Browder W, Smith J W, Vivoda L M, Nichols R L
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
J Infect Dis. 1989 Jun;159(6):1088-94. doi: 10.1093/infdis/159.6.1088.
Acute appendicitis continues as a medical challenge with newer approaches failing to improve diagnostic accuracy. The role of antibiotics in acute nonperforative appendicitis (NPA) remains unclear. In 175 patients studied at two hospitals, preoperative guidelines were used to exclude perforative appendicitis. Nevertheless, 14% of patients were found to have this condition. Surgeon's reports significantly underestimated the diagnosis when compared with the pathologists' reports. Antibiotic prophylaxis in 122 patients with NPA was studied prospectively comparing ceftizoxime (CTZ), cefamandole (CFM), and placebo (PLA). Ceftizoxime decreased the infection rate compared with PLA (0 vs. 8; P less than .01). Use of antibiotics (CTZ or CFM) resulted in decreased infections when compared with PLA (3 vs. 8; P less than .01) and fewer days of hospitalization (3.8 vs. 5.4 d, P less than .005). Analysis of infection risk factors showed no correlations except for failure to administer antibiotics and the finding of a gangrenous appendix. Operative culture results had no predictive value for either infection or pathogen identification. It is recommended that all patients undergoing surgery for NPA be given 1 d of antibiotic prophylaxis.
急性阑尾炎仍然是一个医学难题，新的方法未能提高诊断准确性。抗生素在急性非穿孔性阑尾炎（NPA）中的作用仍不明确。在两家医院研究的175例患者中，术前指南用于排除穿孔性阑尾炎。然而，发现14%的患者患有这种疾病。与病理学家的报告相比，外科医生的报告显著低估了诊断。对122例NPA患者的抗生素预防进行了前瞻性研究，比较了头孢唑肟（CTZ）、头孢孟多（CFM）和安慰剂（PLA）。与PLA相比，头孢唑肟降低了感染率（0比8；P小于0.01）。与PLA相比，使用抗生素（CTZ或CFM）导致感染减少（3比8；P小于0.01），住院天数减少（3.8天比5.4天，P小于0.005）。感染危险因素分析显示，除未使用抗生素和发现坏疽性阑尾外，无相关性。手术培养结果对感染或病原体鉴定均无预测价值。建议所有接受NPA手术的患者给予1天的抗生素预防。
