儿童急性化脓性阑尾炎术后切口感染及疗效分析

Analysis of incision infection and therapeutic effect after operation of acute suppurative appendicitis in children

目的 探析儿童急性化脓性阑尾炎术后发生切口感染的病原菌分布情况、耐药特点及治疗效果。方法 选取95例急性化脓性阑尾炎手术并发切口感染患儿为本次研究对象,收集患儿临床资料,采集患儿切口分泌物进行病原菌培养、鉴定及药敏试验。将切口感染患儿分为两组,对照组采用头孢呋辛钠治疗,观察组采用头孢呋辛钠联合甲硝唑治疗,对比两组患儿住院时间、下床活动时间及不良反应发生情况。结果 95例急性化脓性阑尾炎术后切口感染患儿中,17.89%伴有阑尾粪石(17/95),21.05%伴有阑尾穿孔(20/95)。3岁以下患儿中11例伴阑尾穿孔,穿孔率为39.29%(11/28),3岁以上患儿中9例伴阑尾穿孔,穿孔率为13.43%(9/67),两组患儿阑尾穿孔率差异有统计学意义(P<0.05)。共检出病原菌95株,包括68株革兰阴性菌,22株革兰阳性菌,5株真菌。革兰阴性菌主要为大肠埃希菌(24.21%,23/95)和铜绿假单胞菌(12.63%,12/95)。革兰阳性菌主要为金黄色葡萄球菌(7.37%,7/95)。真菌均为白色假丝酵母菌。革兰阴性菌对氨曲南、庆大霉素、复方新诺明的耐药率高于其他抗菌药物,耐药率分别为55.88%、66.18%、58.82%,对亚胺培南、美罗培南、阿米卡星的耐药率低于其他抗菌药物,耐药率分别为16.18%、19.12%、14.71%。革兰阳性菌对青霉素、头孢曲松、红霉素、克林霉素、左氧氟沙星、庆大霉素、四环素的耐药率高于其他抗菌药物,耐药率分别为90.91%、54.55%、81.82%、77.27%、50%、54.55%、63.64%,对氨苄西林-舒巴坦的耐药率为18.18%,对万古霉素、利奈唑胺的敏感率为100%。观察组患儿住院时间为(5.88±1.55)d,下床活动时间为(4.75±1.47)d,对照组患儿住院时间为(8.13±2.27)d,下床活动时间为(6.66±2.23)d,差异有统计学意义(P<0.05)。观察组患儿总不良反应发生率为8.33%(4/48),对照组为14.89%(7/47),差异无统计学意义(P>0.05)。结论 急性化脓性阑尾炎术后并发切口感染患儿中,3岁以下患儿更容易并发阑尾穿孔。病原菌主要为革兰阴性菌,以大肠埃希菌和铜绿假单胞菌为主,检出的病原菌对临床常用抗菌药物表现出不同程度的耐药情况。联合甲硝唑进行临床治疗,治疗效果优于单独采用头孢呋辛钠,同时不良反应发生率未升高。

Objective To explore the distribution of pathogens,drug resistance characteristics,and treatment effects of incision infections in children with acute suppurative appendicitis after surgery.Methods95childrenwithacute suppurative appendicitis complicated by incision infection during surgery were selected as the study subjects.Clinical data of the children were collected,and incision secretions of the children were collected for pathogen culture,identification and drug susceptibility test.The children with incision infection were divided into two groups.The first group was treated with cefuroxime sodium,while the second group was treated with cefuroxime sodium in combination with metronidazole.The hospitalization time,time of getting out of bed for activities,and occurrence of adverse reactions of the two groups of children patients were compared.Results Among 95 pediatric patients,17.89%were accompanied by appendiceal fecal stones(17/95)and 21.05%were accompanied by appendiceal perforation(20/95).Among children under 3 years old,11 cases had appendiceal perforation,with a perforation rate of 39.29%(11/28).Among children over 3 years old,9 cases had appendiceal perforation,with a perforation rate of 13.43%(9/67).There was a statistically significant difference in the appendiceal perforation rate between the two groups of children(P<0.05).A total of 95 pathogenic bacteria were detected,including 68 Gram negative bacteria,22 Gram positive bacteria,and 5 fungi.Among Gram negative bacteria,the main ones were Escherichia coli(24.21%,23/95)and Pseudomonas aeruginosa(12.63%,12/95).Among Gram positive bacteria,the main one was Staphylococcus aureus(7.37%,7/95).Among fungi,they were all Candida albicans.The resistance rates of Gram-negative bacteria to aztreonam,gentamicin and sulfamethoxazole-trimethoprim were higher than those to other antibacterial drugs,which were 55.88%,66.18%and 58.82%respectively.The resistance rates to imipenem,meropenem and amikacin were lower than those to other antibacterial drugs,which were 16.18%,19.12%and 14.71%respectively.The resistance rates of Gram-positive bacteria to penicillin,ceftriaxone,erythromycin,clindamycin,levofloxacin,gentamicin and tetracycline were higher than those to other antibacterial drugs,which were 90.91%,54.55%,81.82%,77.27%,50%,54.55% and 63.64%respectively.The resistance rate to ampicillin-sulbactam was 18.18%.The susceptibility rates to vancomycin and linezolid were 100%.The hospitalization time of children in the observation group was(5.88±1.55)d,and the time of getting out of bed for activities was(4.75±1.47)d.The hospitalization time of children in the control group was(8.13±2.27)d,and the time of getting out of bed for activities was(6.66±2.23)d.The difference was statistically significant(P<0.05).The total incidence of adverse reactions in the observation group was 8.33%(4/48),and that in the control group was 14.89%(7/47).The difference was not statistically significant(P>0.05).Conclusion Amongchildren with postoperativeacute suppurative appendicitis complicated by incision infection,children under 3 years old were more likely to develop appendiceal perforation.The main pathogens were Gram negative bacteria,mainly Escherichia coli and P.aeruginosa.The detected pathogens showed varying degrees of resistance to commonly used clinical antibiotics.Clinical treatment combined with metronidazole had a better therapeutic effect than using cefuroxime sodium alone,while the incidence of adverse reactions did not increase.