急性阑尾炎术中腹腔脓液病原微生物培养结果与临床分析OA

Objective To investigate the pathogenic microorganism culture results of intra-abdominal pus in patients with acute appendicitis during operation and its clinical significance.Methods A total of 200 patients with acute appendicitis admitted to Wuzhong People's Hospital from February 2024 to February 2025 were enrolled,and intra-abdominal pus was collected for bacterial culture,then the culture results and clinical value were analyzed.Results Pathogenic microorganisms were successfully isolated from 120 of the 200 samples,with a positive rate of 60.00%,including 30 cases of mixed infection.After further isolation,150 bacterial strains and 10 fungal strains were obtained.Statistical analysis showed that Gram-negative bacilli were the main pathogens,and the top three pathogens were Escherichia coli(62.50%),Pseudomonas aeruginosa(12.50%)and Klebsiella pneumoniae(6.25%).Among the 120 culture-positive patients,they were divided into three groups according to pathological types:55 cases(45.83%)of simple suppurative appendicitis,35 cases(29.17%)of simple gangrenous/perforated appendicitis,and 30 cases(25.00%)of mixed type(suppuration combined with gangrene/perforation).The number and rate of mixed infection in the three groups were 2 cases(3.64%)in the simple suppurative group,8 cases(22.86%)in the simple gangrenous/perforated group,and 20 cases(66.67%)in the mixed type group,respectively.The difference in mixed infection rate among the three groups was statistically significant(χ2=42.86,P＜0.001).Further pairwise comparison showed that the mixed infection rate in the mixed type group was significantly higher than that in the simple suppurative group(χ2=38.18,P＜0.001)and the simple gangrenous/perforated group(χ2=13.89,P＜0.001),and the mixed infection rate in the simple gangrenous/perforated group was higher than that in the simple suppurative group(χ2=6.92,P=0.009).For commonly used clinical antibiotics,the sensitivity rates of Escherichia coli to imipenem and meropenem were both 100.00%,99.00%to amikacin,98.00%to piperacillin/tazobactam,97.00%to cefoxitin,and 96.00%to amoxicillin/clavulanate potassium.The sensitivity rate of Pseudomonas aeruginosa to ceftazidime was 100.00%,90.00%to piperacillin/tazobactam and tobramycin,85.00%to piperacillin,80.00%to ciprofloxacin and gentamicin,and 75.00%to aztreonam.Klebsiella pneumoniae showed 100.00%sensitivity to amikacin,aztreonam,ceftriaxone,ceftazidime,cefotaxime,cefoxitin,cefazolin,ciprofloxacin,cefepime,cefuroxime,ertapenem,gentamicin,imipenem,levofloxacin,meropenem,tetracycline and tobramycin,but had low sensitivity rates to amoxicillin/clavulanate potassium(70.00%),piperacillin/tazobactam(60.00%)and piperacillin(20.00%),suggesting that this strain has certain drug resistance to some β-lactam/β-lactamase inhibitor compound preparations in this region.In addition,no extended-spectrum β-lactamases(ESBLs)-producing strains were detected in Klebsiella pneumoniae.In terms of gender distribution,among the 200 patients,120 were males,of whom 100 were culture-positive with a positive rate of 83.33%;80 were females,of whom 20 were culture-positive with a positive rate of 25.00%.The culture positive rate of male patients was higher than that of female patients,with a statistically significant difference(χ2=71.11,P＜0.001).Conclusion Piperacillin/tazobactam,cefoxitin,amoxicillin/clavulanate potassium,amikacin and carbapenem antibiotics have a sensitivity rate of more than 70%against Escherichia coli in patients with acute appendicitis,which can be comprehensively selected combined with disease severity,infection type and drug susceptibility results.Klebsiella pneumoniae has a 100.00%sensitivity rate to amikacin,carbapenems and most cephalosporin antibiotics,but the sensitivity rates to piperacillin/tazobactam(60.00%)and amoxicillin/clavulanate potassium(70.00%)are decreased,so clinical medication should be guided by drug susceptibility results.