小儿急性阑尾炎脓液细菌培养及药敏试验结果分析

目的探讨小儿急性阑尾炎腹腔感染的主要致病菌及药物敏感变化特点，为临床合理应用抗菌素提供依据。方法选择我院收治的急性阑尾炎行阑尾切除术患儿197例，平均年龄（4．9±2．9）岁。按阑尾标本病理结果分为坏疽性阑尾炎组及化脓性阑尾炎组，术中采集腹腔内脓液标本，进行细菌培养及药物敏感试验。分析2组不同病理类型间细菌检出种类及检出率有无差别。结果小儿急性阑尾炎腹腔感染主要致病菌为大肠埃希菌及铜绿假单胞菌。大肠埃希菌中51．3％为产ESBL的大肠埃希菌，除美罗培南外耐药性明显增加。不同病理类型间细菌检出种类及检出率差异无统计学意义（P〉0．05）。结论大肠杆菌仍是小儿急性阑尾炎腹腔感染的主要致病菌，对临床常用抗菌素有明显的耐药性，腹腔内脓液培养及药物敏感试验对抗菌素的选择具有指导作用。

Analysis of bacteria culture and drug sensitivity test in children with acute appendicitis

Objective To provide a basis for the proper application of antibiotics in clinic by investigating major pathogenic bacteria of intra-abdominal infections in children with acute appendicitis and the characteristics of drug sensitivity changes. Methods From January 2006 to December 2008, 197 children patients with acute appendicitis（ 136 boys and 61 girls,mean age ：4.9 ±2.9 years）who underwent appendectomy were enrolled in the investigation. The abdominal cavity pus specimens were eelected during the operation, in order to cultivate the bacteria and test the drug sensitivity. According to the outcome of pathological specimens, these children with acute appendicitis were divided into two groups, gangrenous appendicitis group and suppurative appendicitis group. Whether there existed a difference between the two groups in the aspect of bacteria types and the positive rates of bacteria was analyzed. Results The major pathogenic bacteria in children with caute appendicitis were Escherichia coli and pseudomonas aeruginosa. Super-broad spectral β-lactamase was found in 51. 3% of Escherichia coli, which obviously increased drug resistance to antibiotics except for meropenem. There was no difference between isolated bacteria types and the positive rate of bacteria between the two groups （ P 〉 0.05 ）. Conclusion Escherichia cob is remaining the major pathogenic bacteria in children with caute appendicitis as before, which has high drug resistance rates to routine antibiotics. The cultivation of bacteria and test of drug sensitivity in the abdominal cavity pus may offer guidance in the antibiotic treatment for children with acute appendicitis.