Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
J Pediatr Surg. 2021 Jul;56(7):1145-1149. doi: 10.1016/j.jpedsurg.2021.03.027. Epub 2021 Mar 27.
Through historical comparison with our previous study published 10 years ago, this paper aims to provide latest analysis of local bacteriology of acute complicated appendicitis and evaluate the effects of early escalation of potent antibiotics on course of postoperative recovery.
A 5-year retrospective review of all children receiving emergency laparoscopic appendicectomies for acute appendicitis from December 2014 to November 2019 was conducted.
257 cases of acute appendicitis were included, 126 were complicated appendicitis (38 gangrenous, 88 ruptured). 96 had positive peritoneal swab culture, 53 (42.1%) grew resistant bacterial strains, including extended spectrum beta-lactamase producing E. coli (ESBL E. coli), Pseudomonas aeruginosa, against traditional empirical triple antibiotics. The prevalence had significantly increased over the past decade (p = 0.008). In our patients, piperacillin/tazobactam, ertapenem, gentamicin provided coverage of 69.8%, 45.3% and 45.3% respectively. For patients with early escalation of postoperative antibiotics, no statistical significance was identified in terms of postoperative complications (p = 0.883), or duration of antibiotics (p = 0.0615).
Growing prevalence of resistant strains were observed over the decade. Piperacillin/tazobactam provided the best coverage (69.8%) against resistant bacterial strains in our patients. Early escalation of antibiotics failed to reduce postoperative complications and antibiotics duration.
Clinical Research, Retrospective Historical Comparative Study Level of Evidence: Level III.
通过与我们 10 年前发表的研究进行历史比较，本文旨在提供急性复杂性阑尾炎局部细菌学的最新分析，并评估早期升级强效抗生素对术后恢复过程的影响。
对 2014 年 12 月至 2019 年 11 月期间接受腹腔镜阑尾切除术治疗急性阑尾炎的所有儿童进行了为期 5 年的回顾性研究。
共纳入 257 例急性阑尾炎患者，其中 126 例为复杂性阑尾炎（38 例坏疽性，88 例破裂性）。96 例有阳性腹腔拭子培养，其中 53 例（42.1%）培养出耐药菌，包括产超广谱β-内酰胺酶的大肠杆菌（ESBL 大肠杆菌）、铜绿假单胞菌，对传统经验性三联抗生素耐药。与过去十年相比，耐药菌的患病率显著增加（p=0.008）。在我们的患者中，哌拉西林/他唑巴坦、厄他培南、庆大霉素的覆盖率分别为 69.8%、45.3%和 45.3%。对于术后抗生素早期升级的患者，术后并发症（p=0.883）和抗生素使用时间（p=0.0615）方面无统计学差异。
在过去十年中，耐药菌株的患病率有所增加。哌拉西林/他唑巴坦对我们患者的耐药菌提供了最佳的覆盖（69.8%）。早期升级抗生素并不能降低术后并发症和抗生素使用时间。
临床研究，回顾性历史对照研究 证据等级：III 级。
