儿童急性化脓性阑尾炎脓液细菌培养及耐药性分析

Bacterial culture and drug resistance analysis of pus in children with acute suppurative appendicitis

目的探讨儿童急性化脓性阑尾炎脓液细菌培养及耐药性分析,为合理选择抗菌药物提供依据。方法回顾性研究山西省儿童医院从2019年1-12月行阑尾切除术患儿528例,病理学诊断为急性化脓性阑尾炎,其中473例患儿细菌培养结果为阳性。术中腹腔内有脓液直接抽取,没有明显脓液时切除阑尾后擦拭阑尾腔内脓液获取标本。分析473例细菌培养阳性患儿的临床特点、手术类型、抗菌药物的使用、细菌培养、术后并发症等情况。结果473例细菌培养阳性患儿中培养出919株细菌,其中163例患儿为单一细菌感染,310例患儿为两种以上细菌混合感染。检出细菌数量位居前3位的革兰阴性菌为大肠埃希菌387株、铜绿假单胞菌81株、肺炎克雷伯杆菌35株;位居前3位的革兰阳性菌为咽峡炎链球菌群216株、鸟肠球菌35株、屎肠球菌29株。头孢他啶联合甲硝唑治疗手术部位感染例数与头孢曲松联合甲硝唑比较,差异有统计学意义(P=0.015)。结论经验性使用抗菌药物治疗儿童急性化脓性阑尾炎是安全有效的,对于脓液培养为混合细菌感染,需合理选择抗菌药物,可减少术后并发症。

Objective To investigate the bacterial culture and drug resistance analysis of the pus of children with acute suppurative appendicitis,so as to provide the basis for rational selection of antibiotics.Methods A retrospective study was conducted on 528 children who underwent appendectomy in Shanxi Children's Hospital from January to December 2019.The pathological diagnosis was acute suppurative appendicitis,among which 473 children had positive bacterial culture results.Intraoperative luminal contents of the appendix were swabbed after appendectomy.In patients with periappendiceal abscess,the specimens were obtained from abscess fluid.The clinical characteristics,operation types,use of antibacterial drugs,bacterial culture and postoperative complications of 473 children with positive bacterial culture were analyzed.Results 919 strains of bacteria were cultured from 473 children with positive bacterial culture,among which 163 were single bacterial infection and 310 were mixed bacterial infection.The number of Gram-negative bacteria in the top 3 were Escherichia coli 387,Pseudomonas aeruginosa 81 and Klebsiella pneumoniae 35.The top 3 Gram-positive bacteria were 216 strains of Streptococcus eustachians,35 strains of Enterococcus avians and 29 strains of Enterococcus faecalis.The number of cases of ceftazidime combined with metronidazole in the treatment of surgical site infection was statistically significant compared with that of ceftriaxone combined with metronidazole(P=0.015).Conclusion The empirical use of antibiotics in the treatment of acute suppurative appendicitis in children is safe and effective.For the mixed bacterial infection of pus culture,antimicrobial agents should be selected rationally to reduce postoperative complications.