Ruff M E, Friedland I R, Hickey S M
Department of Pediatrics, Ireland Army Hospital, Ft Knox, Ky.
Arch Pediatr Adolesc Med. 1994 Aug;148(8):853-5. doi: 10.1001/archpedi.1994.02170080083016.
To determine the association between nonperforated appendicitis and Escherichia coli septicemia, and the frequency with which blood cultures are obtained in the clinical setting of appendicitis.
Three case reports of E coli septicemia and nonperforated appendicitis and a retrospective survey.
Children's Medical Center, Dallas, Tex, a primary care and tertiary referral center.
All children admitted in a 2-year period with a diagnosis of appendicitis.
None.
Preoperative blood cultures were obtained in 20 (21%) of 96 patients with histologic evidence of appendicitis. Fifty percent of the patients had gross or microscopic evidence of appendiceal perforation. Twelve (25%) of the 48 patients with perforated appendicitis had blood cultures obtained before the initiation of antimicrobial therapy, and in two of these patients (17%) the results were positive. Blood cultures were drawn before antibiotic therapy in four (8%) of the 48 patients with nonperforated appendicitis, and in two of these the results were positive. The blood culture isolates (coagulase-negative Staphylococcus and E coli) were the same in both groups.
Nonperforated appendicitis and septicemia may be more common than formerly appreciated. Only a prospective study can determine the true incidence of septicemia in children with perforated or nonperforated appendicitis.
确定非穿孔性阑尾炎与大肠杆菌败血症之间的关联，以及在阑尾炎临床情况下进行血培养的频率。
3例大肠杆菌败血症合并非穿孔性阑尾炎的病例报告及一项回顾性调查。
得克萨斯州达拉斯市儿童医疗中心，一家初级保健和三级转诊中心。
所有在2年期间内入院且诊断为阑尾炎的儿童。
无。
96例有阑尾炎组织学证据的患者中，20例（21%）进行了术前血培养。50%的患者有阑尾穿孔的大体或显微镜下证据。48例穿孔性阑尾炎患者中，12例（25%）在开始抗菌治疗前进行了血培养，其中2例（17%）结果为阳性。48例非穿孔性阑尾炎患者中，4例（8%）在抗生素治疗前进行了血培养，其中2例结果为阳性。两组血培养分离出的细菌（凝固酶阴性葡萄球菌和大肠杆菌）相同。
非穿孔性阑尾炎和败血症可能比以前认为的更为常见。只有前瞻性研究才能确定穿孔性或非穿孔性阑尾炎患儿败血症的真实发病率。
