Hang Tian, Chen Qiao-Lin, Li Ya-Hong, Wang Shi-Wen, Jiang Xiao-Hong, Zhu Wei-Chao
Department of Pediatric Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing 314009, Zhejiang Province, China.
Department of Pediatric Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315010, Zhejiang Province, China.
World J Gastrointest Surg. 2025 Apr 27;17(4):104712. doi: 10.4240/wjgs.v17.i4.104712.
Pediatric perforated appendicitis (PPA) is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy. Antibiotic selection differs significantly among pediatric centers, and an ideal postoperative anti-infective approach for PPA management has yet to be established.
To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem (CBP) and cephalosporin (CPS) antibiotics.
We retrospectively analyzed medical records of 65 children (43 boys, 22 girls; mean age 6.92 ± 3.41 years) with PPA who underwent surgery at our hospital between December 2019 and August 2022. Data were collected in September 2023. Based on postoperative antibiotic selection, patients were divided into CBP (32 cases) and CPS (33 cases) groups. Chi-square and T-tests compared recovery outcomes, while univariate and multivariate regression models identified independent factors affecting postoperative recovery.
There were no significant differences between the two groups in gender, age, weight, height, body mass index, baseline ear temperature, or heart rate ( > 0.05). (40.00%) and (24.62%) were the most common pathogens in PPA. Postoperative analysis showed significantly shorter C-reactive protein (CRP) recovery times in the CPS group than in the CBP group [(6.18 ± 1.84) (8.12 ± 3.48) days, = 0.009]. Univariate logistic regression indicated CPS selection (OR = 0.32, 95%CI: 0.10-0.97, = 0.044) was significantly associated with a higher CRP recovery rate within 7 days. Multivariate analysis confirmed CPS selection (OR = 3.49, 95%CI: 1.19-10.24, = 0.023) as an independent factor affecting CRP recovery within 7 days postoperatively.
The choice of CBP or CPS independently affects CRP recovery within 7 days. CBP offers no advantage over CPS in treating PPA, with CPS also demonstrating favorable clinical outcomes.
小儿穿孔性阑尾炎（PPA）是一种严重的急性病症，需要手术干预及术后抗生素治疗。不同儿科中心的抗生素选择差异显著，目前尚未确立理想的PPA术后抗感染治疗方案。
研究小儿PPA的病原菌谱，并总结碳青霉烯类（CBP）和头孢菌素类（CPS）抗生素的术后应用经验。
我们回顾性分析了2019年12月至2022年8月在我院接受手术的65例PPA患儿（43例男孩，22例女孩；平均年龄6.92±3.41岁）的病历。数据于2023年9月收集。根据术后抗生素选择，将患者分为CBP组（32例）和CPS组（33例）。采用卡方检验和T检验比较恢复结果，单因素和多因素回归模型确定影响术后恢复的独立因素。
两组在性别、年龄、体重、身高、体重指数、基线耳温或心率方面无显著差异（>0.05）。（40.00%）和（24.62%）是PPA中最常见的病原体。术后分析显示，CPS组的C反应蛋白（CRP）恢复时间明显短于CBP组[（6.18±1.84）（8.12±3.48）天，=0.009]。单因素逻辑回归表明，选择CPS（OR=0.32，95%CI：0.10-0.97，=0.044）与7天内较高的CRP恢复率显著相关。多因素分析证实，选择CPS（OR=3.49，95%CI：1.19-10.24，=0.023）是影响术后7天内CRP恢复的独立因素。
CBP或CPS的选择独立影响7天内的CRP恢复。在治疗PPA方面，CBP并不比CPS有优势，CPS也显示出良好的临床效果。
