Dougherty S H, Saltzstein E C, Peacock J B, Mercer L C, Cano P
Department of Surgery, Texas Tech University, El Paso 79905.
Arch Surg. 1989 Nov;124(11):1280-3. doi: 10.1001/archsurg.1989.01410110034006.
To study the influence of bacterial culture data on the clinical management of gangrenous or perforated appendicitis, we reviewed records of 104 patients who had been treated empirically with aminoglycoside antibiotics. Culture results appeared to influence antibiotic therapy in only 7 patients (7%). The routine cultures obtained at appendectomy affected therapy in only 2 patients. Discriminant analysis identified postoperative infectious complications and related factors as the principal determinants of culture utility. We conclude that, in patients with perforated appendicitis treated empirically with aminoglycoside combination regimens, culture results were seldom used for clinical management except in instances of postoperative infectious complication. Routine cultures and Gram's stains of perforated appendicitis, however, should still be obtained (1) to allow epidemiologic tracking in the hospital; (2) to identify organisms that are recovered infrequently but may cause serious disease (eg, Clostridium); and (3) because newer antibiotics are replacing aminoglycosides in the treatment of perforated appendicitis.
为研究细菌培养数据对坏疽性或穿孔性阑尾炎临床治疗的影响，我们回顾了104例接受氨基糖苷类抗生素经验性治疗患者的记录。培养结果似乎仅对7例患者（7%）的抗生素治疗产生影响。阑尾切除术中进行的常规培养仅对2例患者的治疗有影响。判别分析确定术后感染并发症及相关因素是培养结果实用性的主要决定因素。我们得出结论，对于接受氨基糖苷类联合方案经验性治疗的穿孔性阑尾炎患者，培养结果很少用于临床治疗，除非出现术后感染并发症。然而，对于穿孔性阑尾炎仍应进行常规培养和革兰氏染色，原因如下：（1）以便在医院内进行流行病学追踪；（2）识别不常分离出但可能导致严重疾病的微生物（如梭状芽孢杆菌）；（3）因为在穿孔性阑尾炎的治疗中，新型抗生素正在取代氨基糖苷类药物。
