Department of Surgery, San Gerardo Hospital, University of Milan Bicocca, G.B. Pergolesi 33, Monza, Italy.
Eur J Trauma Emerg Surg. 2020 Aug;46(4):835-839. doi: 10.1007/s00068-018-1031-7. Epub 2018 Oct 12.
Current use of antimicrobial therapy is prophylactic, empirical and broad spectrum. But, the age-old practice of obtaining cultures still remain. The aim of this study was to evaluate bacterial etiology and adequacy of antibiotic prophylaxis in patients diagnosed with acute appendicitis to help determine the utility of intraoperative cultures in guiding clinical decision-making.
A retrospective analysis of a prospectively constructed database of all patients who underwent appendectomy from September 2013 to November 2016 was performed.
456 patients underwent surgery for acute appendicitis in our academic hospital. 101 patients (22.1%) had intraoperative swabs taken, and the cultures were positive in 57.4% of patients. These 101 patients comprise our study group. The most commonly recovered species were E. coli, Streptococcus spp., Bacteroides fragilis, Enterococcus faecium, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Proteus. In the comparison between positive and negative swab, there were no differences in terms of surgical site infection, deep infection, and in terms of Clavien-Dindo classification. An appropriate empiric therapy was set in 88.5% and inappropriate in 11.5%. No differences in terms of surgical site infection or in length of stay (p = 0.657) were found, with a median of 7 days in both groups.
The etiological agents causing peritonitis due to acute appendicitis are predictable and empiric-targeted antibiotic therapy is effective in a high percentage of patients. The postoperative patient outcome may be dependent on the severity of the appendicitis more than on the results of the swab at the time of surgery. In this study, intraoperative culture was not associated with the choice of antibiotics, incidence of SSI, DPI or the length of stay.
目前，抗菌治疗是预防性的、经验性的和广谱性的。但是，古老的培养物获取实践仍然存在。本研究的目的是评估诊断为急性阑尾炎患者的细菌病因和抗生素预防的充分性，以帮助确定术中培养物在指导临床决策中的效用。
对 2013 年 9 月至 2016 年 11 月期间所有接受阑尾切除术的患者前瞻性构建的数据库进行回顾性分析。
我院有 456 例患者因急性阑尾炎接受手术治疗。101 例患者（22.1%）进行了术中拭子取样，其中 57.4%的患者培养阳性。这 101 例患者构成了我们的研究组。最常见的恢复物种是大肠杆菌、链球菌、脆弱拟杆菌、屎肠球菌、铜绿假单胞菌、肺炎克雷伯菌和变形杆菌。在拭子阳性和阴性的比较中，在手术部位感染、深部感染和 Clavien-Dindo 分类方面没有差异。设定了适当的经验性治疗方案的占 88.5%，不适当的占 11.5%。在手术部位感染或住院时间方面（p=0.657）没有差异，两组的中位数均为 7 天。
引起急性阑尾炎腹膜炎的病原体是可预测的，经验性靶向抗生素治疗在很大一部分患者中是有效的。术后患者的转归可能取决于阑尾炎的严重程度，而不是手术时拭子的结果。在本研究中，术中培养与抗生素的选择、SSI、DPI 的发生率或住院时间无关。
