阑尾切除术后切口感染患儿PCT、ESR和CRP变化及切口脓液病原菌分析

The changes of PCT, ESR and CRP in children with appendectomy incision infection and analysis of pathogenic bacteria in incision pus

目的研究阑尾切除术后切口感染患儿血清C-反应蛋白(CRP)、降钙素原(PCT)和红细胞沉降率(ESR)水平变化及切口脓液病原菌分布。方法选取2014年7月至2019年7月我院收治的100例阑尾切除术后切口感染患儿为观察组,对照组选取同期来我院进行体检的80例健康儿童。对比两组对象血清CRP、PCT和ESR水平,同时分析观察组患儿阑尾切除术后切口脓液病原菌的构成。结果观察组患儿血清CRP、PCT和ESR水平显著高于对照组(均P<0.05)。送检的100例脓液及脓性分泌物标本中检出细菌51例,检出率为51.00%。共分离得到病原菌55株(其中有4例为2种细菌混合感染),病原菌种类共13种,其中革兰阴性菌39株(70.91%),革兰阳性菌16株(29.09%),主要病原菌为大肠埃希菌(49.09%)、肺炎克雷伯菌(10.91%)、金黄色葡萄球菌(9.09%)和铜绿假单胞菌(5.45%)。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对厄他培南、亚胺培南、美罗培南、哌拉西林/他唑巴坦、氨曲南较为敏感。结论阑尾切除术后切口感染患儿血清PCT、CRP和ESR水平较高,主要病原菌为大肠埃希菌。

Objective To explore the changes of PCT,ESR and CRP levels in children with incision infection after appendectomy and analyze the pathogenic bacteria in incision pus.Methods One hundred children with incision infection after appendectomy who were treated in our hospital from July 2014 to July 2019 were selected as the observation group,and 80 healthy children who came to our hospital for physical examination during the same period were selected as the control group.The levels of serum CRP,PCT and ESR of the children were compared between groups,and the composition of pathogens in incision pus in the observation group were analyzed.Results The levels of serum CRP,PCT and ESR in the observation group were significantly higher than those in the control group(all P<0.05).Among the 100 samples of pus and purulent secretions sent for examination,51 were positive,with a detection rate of 51.00%.A total of 55 strains of pathogenic bacteria were isolated(among which 4 were mixed infection with two kinds of bacteria),and 13 kinds of pathogenic bacteria were isolated.There were 39 Gram-negative bacteria(70.91%)and 16 Gram-positive bacteria(29.09%),the main pathogens were Escherichia coli(49.09%),Klebsiella pneumoniae(10.91%),Staphylococcus aureus(9.09%)and Pseudomonas aeruginosa(5.45%)being prominent.Drug susceptibility test showed that Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa were sensitive to Ertapenem,Imipenem,Meropenem,Piperacillin/Tazobatam,and Amtronam.Conclusion The levels of PCT,ESR and CRP were higher in children with incision infection after appendectomy,and Escherichia coli was the main pathogen of the infection.