Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom.
Department of Microbiology, Birmingham Children's Hospital, Birmingham, United Kingdom.
Surg Infect (Larchmt). 2023 Mar;24(2):183-189. doi: 10.1089/sur.2022.220. Epub 2023 Feb 6.
We sought to investigate the value of intra-operative microbiology samples in pediatric appendicitis. Proposed benefits include tailoring post-operative antimicrobial management, risk-stratifying patients, and reducing post-operative intra-abdominal abscess formation. All cases of appendicitis managed with appendicectomy in a single center were collected from January 2015 to August 2020. Intra-operative microbiology samples were taken routinely. Post-operative outcomes were analyzed with reference to culture and sensitivity results. Histologic findings were further categorized as normal, simple, or complex. Six hundred seventy-eight children had appendicectomies, and 608 had both microbiology and histology samples taken. Intra-abdominal fluid collection and subsequent intervention rates were 22% and 9%, respectively. There were more collections in those with a culture positive result (p < 0.001), and those growing each of three recognized organisms, (p < 0.001), (p = 0.01), and group (p < 0.001). Intervention rate was higher in the culture-positive result group (p = 0.002) and the group (p < 0.001). This study shows an increased risk of developing a collection with the isolation of one of three key organisms ( group). Sersoal swabs are an effective and practical method of gathering information on organisms. Microbiologic yield was correlated to the severity of appendicitis. Isolation of increases the incidence of collections to 50%. This is useful to empower surgeons to prognosticate patients' potential outcomes based on both intra-operative, and microbiologic findings, and is useful in counseling patients and managing expectations. A prolonged course of antibiotic agents or higher dose may mitigate this risk.
我们旨在探究术中微生物样本在小儿阑尾炎中的应用价值。提出的益处包括定制术后抗菌药物管理、对患者进行风险分层以及降低术后腹腔脓肿形成的风险。本研究收集了 2015 年 1 月至 2020 年 8 月期间于单一中心行阑尾切除术治疗的所有阑尾炎病例。术中常规采集微生物样本。术后结局参照培养和药敏结果进行分析。组织学发现进一步分为正常、单纯和复杂。678 例患儿行阑尾切除术，其中 608 例同时留取了微生物和组织学样本。术后发生腹腔积液和需要干预的比例分别为 22%和 9%。阳性培养组的积液发生率更高（p<0.001），且在培养出三种公认的病原体时，发生率更高，具体为 （p<0.001）、 （p=0.01）和 组（p<0.001）。阳性培养组的干预率更高（p=0.002）， 组的干预率更高（p<0.001）。本研究表明，在分离出三种关键病原体（ 组）之一的情况下，发生积液的风险会增加。拭子是一种获取病原体信息的有效且实用的方法。微生物学检出率与阑尾炎的严重程度相关。分离出 会使积液的发生率增加至 50%。这有助于外科医生根据术中及微生物学结果对患者的潜在结局进行预测，并有助于与患者沟通和管理预期。延长抗生素疗程或增加剂量可能会降低这种风险。
