Mark-Christensen Anders, Bro Sørensen Ditte, Qvist Niels, Justesen Ulrik Stenz, Möller Sören, Ellebæk Mark Bremholm
Department of Surgery, Odense University Hospital, Odense, Denmark.
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark.
Langenbecks Arch Surg. 2024 Aug 8;409(1):244. doi: 10.1007/s00423-024-03428-3.
The distinction between complicated and uncomplicated acute appendicitis (AA) is important as it guides postoperative antibiotic treatment. A diagnosis based on intraoperative findings is imprecise and standard cultivation of peritoneal fluid is generally time-consuming with little clinical benefit. The aim of this study was to examine if cultivation of peritoneal fluid in acute appendicitis could reliably detect bacteria within 24 h.
Patients older than 18 years undergoing laparoscopic appendectomy were prospectively enrolled at two surgical departments after informed consent was obtained. Periappendicular fluid was collected prior to appendectomy and sent for cultivation. Sensitivity, specificity and positive and negative predictive values were calculated with 95% confidence intervals (CIs) using 72-hour cultivation results as the gold standard. Patients with complicated AA as determined by the surgeon, received a three-day course of oral antibiotics. Postoperative infectious complications within 30 days after surgery were registered.
From July 2020 to January 2021, 101 patients were included. The intraoperative diagnosis was complicated AA in 34 cases. Of these patients, six (17.6%) had bacteria cultured within 24 h after surgery, leading to a sensitivity of 60% and a specificity of 100%. The positive and negative predictive values were 1.00 and 0.96, respectively. Seven patients developed a postoperative infection (five superficial wound infections and two intra-abdominal abscess). In all cases with a positive cultivation result, the intraoperative diagnosis was complicated appendicitis and a postoperative course of antibiotics prescribed.
Twenty-four-hour cultivation of the peritoneal fluid in acute appendicitis is a valid indicator for peritoneal bacterial contamination. Randomized studies are necessary to determine if this approach is suitable for targeting postoperative antibiotic treatment as a means to prevent overtreatment without increasing the risk of infectious complications.
区分复杂性和非复杂性急性阑尾炎（AA）很重要，因为这会指导术后抗生素治疗。基于术中发现的诊断并不精确，而腹膜液的标准培养通常耗时且临床益处不大。本研究的目的是检验急性阑尾炎患者腹膜液培养能否在24小时内可靠地检测出细菌。
在获得知情同意后，对两个外科科室中年龄超过18岁且接受腹腔镜阑尾切除术的患者进行前瞻性纳入。在阑尾切除术前收集阑尾周围液体并送去培养。以72小时培养结果作为金标准，计算敏感性、特异性以及阳性和阴性预测值，并给出95%置信区间（CI）。由外科医生判定为复杂性AA的患者接受为期三天的口服抗生素疗程。记录术后30天内的感染性并发症。
2020年7月至2021年1月，共纳入101例患者。术中诊断为复杂性AA的有34例。在这些患者中，6例（17.6%）术后24小时内培养出细菌，敏感性为60%，特异性为100%。阳性和阴性预测值分别为1.00和0.96。7例患者发生术后感染（5例浅表伤口感染和2例腹腔内脓肿）。在所有培养结果为阳性的病例中，术中诊断均为复杂性阑尾炎且术后开具了抗生素疗程。
急性阑尾炎患者腹膜液的24小时培养是腹膜细菌污染的有效指标。需要进行随机研究来确定这种方法是否适合作为靶向术后抗生素治疗的手段，以防止过度治疗且不增加感染性并发症的风险。
