Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
J Pediatr Surg. 2022 Sep;57(9):102-106. doi: 10.1016/j.jpedsurg.2021.12.003. Epub 2021 Dec 9.
Intraabdominal abscesses (IAA) are a common complication following appendectomy. Empiric antibiotic regimens may fail to prevent IAA due to changes in bacterial resistance. We aim to describe the bacteriology of pediatric patients requiring drainage of an IAA after an appendectomy for appendicitis.
We performed a retrospective study of patients ≤18 years who underwent percutaneous drainage of an IAA following appendectomy a single U.S. children's hospital between 2015 and 2018. Patient demographics, appendicitis characteristics, antibiotic regimens, and culture data were collected.
In total, 71 patients required drainage of an IAA of which 48 (67%) were male, the average age was 9.81 (SD 3.31) years and 68 (95.7%) having complicated appendicitis. Ceftriaxone/metronidazole was the most common empiric regimen prior to IAA drainage occurring in 64 (90.1%) patients. IAA cultures isolated organisms in 34 (47.9%) patients. Of those with positive cultures, 17 (50%) cases demonstrated an antimicrobial resistant organism. Most notably, 20% of Escherichia coli was resistant to the empiric regimen. Empiric antimicrobial regimens did not appropriately cover 92.3% of Pseudomonas aeruginosa cultures or 100% of Enterococcus species cultures. Antimicrobial regimens were changed following IAA drainage in 30 (42.2%) instances with 23 (32.4%) instances due to resistance in culture results or lack of appropriate empiric antimicrobial coverage.
IAA culture data following appendectomy for appendicitis frequently demonstrates resistance to or lack of appropriate coverage by empiric antimicrobial regimens. These data support close review of IAA culture results to identify prevalent resistant pathogens along with local changes in resistance.
Level III.
腹腔脓肿（IAA）是阑尾切除术后的常见并发症。由于细菌耐药性的变化，经验性抗生素治疗方案可能无法预防 IAA。我们旨在描述阑尾切除术后因阑尾炎行经皮引流 IAA 的儿科患者的细菌学特征。
我们对 2015 年至 2018 年期间在美国一家儿童医院行经皮引流 IAA 的≤18 岁患者进行了回顾性研究。收集了患者人口统计学、阑尾炎特征、抗生素方案和培养数据。
共有 71 例患者需要引流 IAA，其中 48 例（67%）为男性，平均年龄为 9.81（SD 3.31）岁，68 例（95.7%）为复杂性阑尾炎。在发生 IAA 引流之前，头孢曲松/甲硝唑是最常见的经验性治疗方案，有 64 例（90.1%）患者使用。IAA 培养分离出 34 例（47.9%）患者的细菌。在阳性培养物中，17 例（50%）存在耐药菌。值得注意的是，20%的大肠杆菌对经验性治疗方案耐药。经验性抗菌方案不能充分覆盖 92.3%的铜绿假单胞菌培养物或 100%的肠球菌培养物。在 30 例（42.2%）患者中，在 IAA 引流后改变了抗菌方案，其中 23 例（32.4%）是因为培养结果耐药或缺乏适当的经验性抗菌覆盖。
阑尾切除术后因阑尾炎行 IAA 引流后的培养数据常显示对经验性抗菌方案耐药或覆盖不足。这些数据支持密切审查 IAA 培养结果，以确定流行的耐药病原体，并根据当地耐药情况进行调整。
III 级。
