Mosdell D M, Morris D M, Fry D E
Department of Surgery, University of New Mexico School of Medicine, Albuquerque 87131.
Am J Surg. 1994 Mar;167(3):313-6. doi: 10.1016/0002-9610(94)90207-0.
We retrospectively reviewed 70 cases of perforated appendicitis in children to examine the relationship between postoperative antibiotic selection and culture results from the peritoneal cavity. Initial antibiotic therapy chosen for the children consisted of a three-drug combination in 54 (77%) patients. Peritoneal cultures were performed in 58 (83%) patients. Escherichia coli and Bacteriodes fragilis were the most common bacterial isolates from the peritoneal culture. Only 7 (10%) patients had their antibiotic regimen changed after the culture results were available, of which 2 changes brought drug therapy into compliance with the cultures and 5 changes were inappropriate with respect to the peritoneal cultures. Of the remaining 51 patients with culture data available, 39 should have had changes to bring the antibiotic therapy into compliance with the observed culture results. These data indicate that surgeons select antibiotic therapy for perforated appendicitis in children based on assumptions of which organisms should be present in the infection and not on culture data. There appears to be no clinical usefulness to the routine culturing of the peritoneal cavity in children with perforated appendicitis.
我们回顾性分析了70例儿童穿孔性阑尾炎病例，以研究术后抗生素选择与腹腔培养结果之间的关系。为这些儿童选择的初始抗生素治疗方案中，54例（77%）患者采用三联药物组合。58例（83%）患者进行了腹腔培养。大肠埃希菌和脆弱拟杆菌是腹腔培养中最常见的分离菌株。只有7例（10%）患者在获得培养结果后更改了抗生素治疗方案，其中2例更改使药物治疗符合培养结果，5例更改相对于腹腔培养结果是不恰当的。在其余51例有培养数据的患者中，39例应更改抗生素治疗以使其符合观察到的培养结果。这些数据表明，外科医生为儿童穿孔性阑尾炎选择抗生素治疗是基于对感染中应存在何种微生物的假设，而非基于培养数据。对于穿孔性阑尾炎儿童常规进行腹腔培养似乎没有临床实用性。
