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基于腹腔积液培养的小儿复杂性阑尾炎的最佳一线抗生素治疗

Optimal First-Line Antibiotic Treatment for Pediatric Complicated Appendicitis Based on Peritoneal Fluid Culture.

作者信息

Aiyoshi Tsubasa, Masumoto Kouji, Tanaka Nao, Sasaki Takato, Chiba Fumiko, Ono Kentaro, Jimbo Takahiro, Urita Yasuhisa, Shinkai Toko, Takayasu Hajime, Hitomi Shigemi

机构信息

Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Department of Infectious Diseases, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

出版信息

Pediatr Gastroenterol Hepatol Nutr. 2021 Nov;24(6):510-517. doi: 10.5223/pghn.2021.24.6.510. Epub 2021 Nov 5.

DOI:10.5223/pghn.2021.24.6.510
PMID:34796095
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8593360/
Abstract

PURPOSE

Consensus is lacking regarding the optimal antibiotic treatment for pediatric complicated appendicitis. This study determined the optimal first-line antibiotic treatment for pediatric patients with complicated appendicitis based on peritoneal fluid cultures.

METHODS

This retrospective study examined the cases of pediatric patients who underwent appendectomy for complicated appendicitis at our institution between 2013 and 2019. Peritoneal fluid specimens obtained during appendectomy were cultured for the presence of bacteria.

RESULTS

Eighty-six pediatric patients were diagnosed with complicated appendicitis. Of them, bacteria were identified in 54 peritoneal fluid samples. The major identified bacteria were (n=36 [66.7%]), (n=28 [51.9%]), (n=25 [46.3%]), (n=10 [18.5%]), (n=9 [16.7%]), (n=9 [16.7%]), and (n=6 [11.1%]). An antibiotic susceptibility analysis showed was inhibited by sulbactam/ampicillin in 43.8% of cases versus cefmetazole in 100% of cases. Tazobactam/piperacillin and meropenem inhibited the growth of 96.9-100% of the major identified bacteria. (100% vs. 84.6%) and (100% vs. 80.0%) were more susceptible to amikacin than gentamicin.

CONCLUSION

Tazobactam/piperacillin or meropenem is a reasonable first-line antibiotic treatment for pediatric complicated appendicitis. In the case of aminoglycoside use, amikacin is recommended.

摘要

目的

对于小儿复杂性阑尾炎的最佳抗生素治疗方案，目前尚无共识。本研究基于腹腔液培养确定小儿复杂性阑尾炎患者的最佳一线抗生素治疗方案。

方法

这项回顾性研究检查了2013年至2019年间在我院因复杂性阑尾炎接受阑尾切除术的小儿患者病例。对阑尾切除术中获取的腹腔液标本进行细菌培养。

结果

86例小儿患者被诊断为复杂性阑尾炎。其中，在54份腹腔液样本中鉴定出细菌。鉴定出的主要细菌为[具体细菌名称未给出，用符号代替]（n = 36 [66.7%]）、[具体细菌名称未给出，用符号代替]（n = 28 [51.9%]）、[具体细菌名称未给出，用符号代替]（n = 25 [46.3%]）、[具体细菌名称未给出，用符号代替]（n = 10 [18.5%]）、[具体细菌名称未给出，用符号代替]（n = 9 [16.7%]）、[具体细菌名称未给出，用符号代替]（n = 9 [16.7%]）和[具体细菌名称未给出，用符号代替]（n = 6 [11.1%]）。抗生素敏感性分析显示，在43.8%的病例中[具体细菌名称未给出，用符号代替]对舒巴坦/氨苄西林敏感，而在100%的病例中对头孢美唑敏感。他唑巴坦/哌拉西林和美罗培南抑制了96.9 - 100%的主要鉴定细菌的生长。[具体细菌名称未给出，用符号代替]（100%对84.6%）和[具体细菌名称未给出，用符号代替]（100%对80.0%）对阿米卡星比对庆大霉素更敏感。

结论

他唑巴坦/哌拉西林或美罗培南是小儿复杂性阑尾炎合理的一线抗生素治疗方案。在使用氨基糖苷类药物的情况下，推荐使用阿米卡星。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4cde/8593360/2b245340188f/pghn-24-510-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4cde/8593360/2b245340188f/pghn-24-510-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4cde/8593360/2b245340188f/pghn-24-510-g001.jpg

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2
Intraoperative cultures during appendectomy in children are poor predictors of pathogens and resistance patterns in cultures from postoperative abscesses.儿童阑尾切除术中的术中培养对于术后脓肿培养中的病原体及耐药模式而言，预测能力较差。
Pediatr Surg Int. 2019 Mar;35(3):341-346. doi: 10.1007/s00383-018-04428-3. Epub 2019 Jan 8.
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Outcome of early discharge protocol after appendectomy for pediatric acute appendicitis.
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Pediatr Int. 2017 Jul;59(7):803-806. doi: 10.1111/ped.13290.
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The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection.外科感染学会关于腹腔内感染管理的修订指南。
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