儿童阑尾炎手术中脓液培养对临床抗生素应用的指导价值分析OA北大核心

Objective To explore the guiding value of intraoperative pus culture for clinical antibiotic dosing for acute appendicitis in children.Methods A retrospective study was conducted for 323 cases of intr-aoperative pus culture from July 2020 to October 2022.A follow-up period of 30(22,33)months was completed in November 2023 by telephone plus electronic information system for outpatient and inpatient cares.According to whether appendiceal perforation occurs,the patients are divided into perforated group and unperforated group.Positive rate of intraoperative pus bacteria culture,distribution of positive strains,drug sensitivity test results of common pathogens,clinical dosing of empirical antibiotics,empirical antibiotic dosing,adjustment and complica-tions in positive cases of pus culture,clinical outcome of cases with inconsistency between empirical antibiotic dosing and drug sensitivity results were summarized.Results The positive rate of bacterial culture in intraop-erative pus samples from 323 cases was 65.32％(211/323).The positive rate of bacterial culture in the non-perforation group was 17.28％(14/81),while that in the perforation group was 81.41％(197/242).The pos-itive rate of intraoperative pus culture in the non-perforation group was significantly lower than that in the perfo-ration group(P＜0.001).A total of 118 strains of bacteria were cultured from 323 pus samples.The top three Gram-negative bacilli were as follows:63 strains of Escherichia coli(53.38％,63/118),27 strains of Pseudo-monas aeruginosa(22.88％,27/118),and 3 strains of Klebsiella pneumoniae(2.54％,3/118).For Gram-positive cocci,there were 6 cases each of Streptococcus constellatus and Streptococcus anginosus(5.08％,6/118),and 2 cases each of Streptococcus group G and Enterococcus avium group D(1.69％,2/118).Piperacil-lin/Tazobactam,imipenem,meropenem,tigecycline,ertapenem,amikacin were 100％sensitive to Escherichia coli.The sensitivity rates of cefoperazone/sulbactam,ceftazidime and ceftriaxone to Escherichia coli were 98.41％,77.77％and 61.9％,respectively.The sensitivity rate of piperacillin/Tazobactam,meropenem,cef-operazone/sulbactam,ceftazidime and cefepime to Pseudomonas aeruginosa was 100％.The sensitivity rates of linezolid,vancomycin and levofloxacin to G+cocci were 100％.Most patients in the non-perforated group(81 cases)were treated with cefoperazone/sulbactam or ceftazidime+metronidazole:32 cases(39.51％,32/81)of cefoperazone/sulbactam+metronidazole,29 cases(35.8％,29/81)of ceftazidime+metronidazole.The perforation group(242 cases)was mainly treated with ertapenem or cefoperazone/sulbactam+metronidazole:141 cases(58.26％,141/242)of ertapenem+metronidazole,89 cases(36.78％,89/242)of cefoperazone/sulbactam+metronidazole.There were 112 cases of common pus culture positive pathogenic bacteria,only 3 cases adjusted antibiotics according to the results of pus culture and drug sensitivity identification,and a total of 11 cases had postoperative complications.The complication rate in children whose empirical antibiotics were in-consistent with the results of drug sensitivity tests was 11.6％(5/43),while the complication rate in cases treated with sensitive antibiotics was 8.7％(6/69).There was no statistically significant difference between the two groups(P=0.612).Conclusions Regardless of whether appendix is perforated or not,for children with-out special underlying diseases,real-time feedback guiding value of intraoperative pus culture is limited for post-operative antibiotic dosing.