Department of Surgery, Chung-Ang University College of Medicine, 102 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, South Korea.
Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.
Int J Colorectal Dis. 2018 Apr;33(4):441-447. doi: 10.1007/s00384-018-2992-z. Epub 2018 Feb 27.
Essential treatment of acute appendicitis is surgical resection with the use of appropriate antibiotics. In order to effectively treat acute appendicitis, it is important to identify the microorganism of acute appendicitis and evaluate the effective antibiotics.
A total of 694 patients who underwent appendectomy for acute appendicitis and had positive microbial result between 2006 and 2015 were recruited. For microbial assessment, luminal contents of the appendix were swabbed after appendectomy. In patients with periappendiceal abscess, the specimens were obtained from abscess fluid. The patient characteristics, operative data, use of antibiotics, the results of microbiology, and postoperative morbidities including surgical site infection (SSI) were retrospectively reviewed.
The mean age was 38.2 (± 19.8) years, and 422 patients (60.8%) were male. Most of the operations were performed by conventional laparoscopy (83.1%), followed by single-port laparoscopy (11.8%). The most common microorganism was Escherichia coli (64.6%), which was susceptible to amoxicillin/clavulanate, ciprofloxacin, most cephalosporins, piperacillin/tazobactam, and imipenem. The second most common microorganism was Pseudomonas aeruginosa (16.4%), which was resistant to amoxicillin/clavulanate and cefotaxime. The rate of postoperative morbidity was 8.6%, and the most common type was superficial SSI (6.2%), followed by ileus (1.2%), gastroenteritis (0.7%), and organ/space SSI (0.3%). P. aeruginosa (odds ratio = 2.128, 95% confidence interval 1.077-4.206, P = 0.030) was the only significant microorganism associated with SSI according to multivariate analysis adjusting for other clinical factors.
In perforated appendicitis, the use of empirical antibiotics seems to be safe. In some cases of Pseudomonas infection, adequate antibiotics should be considered.
急性阑尾炎的基本治疗方法是手术切除，并使用适当的抗生素。为了有效治疗急性阑尾炎，重要的是要确定急性阑尾炎的微生物，并评估有效的抗生素。
共纳入 2006 年至 2015 年间因急性阑尾炎接受阑尾切除术且微生物检测阳性的 694 例患者。为了进行微生物评估，在阑尾切除术后对阑尾的腔内容物进行拭子取样。对于阑尾周围脓肿的患者，从脓肿液中获取标本。回顾性分析患者特征、手术数据、抗生素使用、微生物学结果以及包括手术部位感染（SSI）在内的术后并发症。
患者的平均年龄为 38.2（±19.8）岁，其中 422 例（60.8%）为男性。大多数手术采用传统腹腔镜（83.1%），其次是单孔腹腔镜（11.8%）。最常见的微生物是大肠杆菌（64.6%），对阿莫西林/克拉维酸、环丙沙星、大多数头孢菌素类、哌拉西林/他唑巴坦和亚胺培南敏感。第二常见的微生物是铜绿假单胞菌（16.4%），对阿莫西林/克拉维酸和头孢噻肟耐药。术后发病率为 8.6%，最常见的类型是浅表 SSI（6.2%），其次是肠梗阻（1.2%）、胃肠炎（0.7%）和器官/空间 SSI（0.3%）。根据多因素分析，调整其他临床因素后，铜绿假单胞菌（比值比=2.128，95%置信区间 1.077-4.206，P=0.030）是唯一与 SSI 显著相关的微生物。
在穿孔性阑尾炎中，经验性使用抗生素似乎是安全的。在某些铜绿假单胞菌感染的情况下，应考虑使用足够的抗生素。
