1 Department of Pediatrics, Children's National Health System, Washington, DC.
2 Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Surg Infect (Larchmt). 2019 Jul;20(5):399-405. doi: 10.1089/sur.2018.234. Epub 2019 Mar 15.
Appendicitis is the most common pediatric surgical emergency and one of the most common indications for antibiotic use in hospitalized children. The antibiotic choice differs widely across children's hospitals, and the optimal regimen for perforated appendicitis remains unclear. We conducted a retrospective cohort study comparing initial antibiotic regimens for perforated appendicitis at a large tertiary-care children's hospital. Children hospitalized between January 2011 and March 2015 who underwent surgery for perforated appendicitis were identified by ICD-9 codes with confirmation by chart review. Patients were excluded if they had been admitted ≥48 hours prior to diagnosis, had a history of appendicitis, received inotropic agents, were immunocompromised, or were given an antibiotic regimen other than ceftriaxone plus metronidazole (CTX/MTZ) or an anti-pseudomonal drug (cefepime, piperacillin/tazobactam, ciprofloxacin, imipenem, or meropenem) within the first two days after diagnosis. The primary outcome of interest was post-operative complications, defined as development of an incisional infection or abscess within six weeks of hospital discharge. Of the 353 children who met the inclusion criteria, 252 (71%) received CTX/MTZ and the others received an anti-pseudomonal regimen. A post-operative complication occurred in 37 (14.7%) of the CTX/MTZ group versus 18 (17.8%) of the anti-pseudomonal group. Antibiotic-related complications occurred in 4.4% of children on CTX/MTZ and 6.9% of children on anti-pseudomonal antibiotics (p = 0.32). In a multivariable logistic regression model adjusting for sex, age, ethnicity, and duration of symptoms prior to presentation, the adjusted odds ratio for post-operative complications in children receiving anti-pseudomonal antibiotics was 1.25 (95% confidence interval 0.66-2.40). Post-operative complication rates did not differ for children treated with CTX/MTZ versus a broader-spectrum regimen.
阑尾炎是最常见的小儿外科急症之一，也是住院儿童中最常见的抗生素使用指征之一。儿童医院之间的抗生素选择差异很大，穿孔性阑尾炎的最佳治疗方案仍不清楚。我们对一家大型三级儿童保健医院的穿孔性阑尾炎初始抗生素治疗方案进行了回顾性队列研究。通过 ICD-9 编码识别 2011 年 1 月至 2015 年 3 月期间因穿孔性阑尾炎接受手术的住院患儿，并通过病历回顾进行确认。如果患者在诊断前已住院≥48 小时、有阑尾炎病史、使用正性肌力药物、免疫功能低下或在诊断后前 2 天内接受头孢曲松加甲硝唑（CTX/MTZ）或抗假单胞菌药物（头孢吡肟、哌拉西林/他唑巴坦、环丙沙星、亚胺培南或美罗培南）以外的抗生素治疗方案，则将患者排除在外。主要观察指标是术后并发症，定义为出院后 6 周内发生切口感染或脓肿。符合纳入标准的 353 例患儿中，252 例（71%）接受 CTX/MTZ 治疗，其余患儿接受抗假单胞菌治疗方案。CTX/MTZ 组术后并发症发生率为 37 例（14.7%），抗假单胞菌组为 18 例（17.8%）。CTX/MTZ 组患儿抗生素相关并发症发生率为 4.4%，抗假单胞菌组为 6.9%（p=0.32）。在校正性别、年龄、种族和就诊前症状持续时间等因素的多变量逻辑回归模型中，接受抗假单胞菌抗生素治疗的患儿术后并发症的调整比值比为 1.25（95%置信区间 0.66-2.40）。接受 CTX/MTZ 与更广泛的抗生素治疗方案的患儿术后并发症发生率无差异。
