PDF(Pubmed)
Abstract：
BACKGROUND: The distinction between complicated and uncomplicated acute appendicitis (AA) is important as it guides postoperative antibiotic treatment. A diagnosis based on intraoperative findings is imprecise and standard cultivation of peritoneal fluid is generally time-consuming with little clinical benefit. The aim of this study was to examine if cultivation of peritoneal fluid in acute appendicitis could reliably detect bacteria within 24 h.
METHODS: Patients older than 18 years undergoing laparoscopic appendectomy were prospectively enrolled at two surgical departments after informed consent was obtained. Periappendicular fluid was collected prior to appendectomy and sent for cultivation. Sensitivity, specificity and positive and negative predictive values were calculated with 95% confidence intervals (CIs) using 72-hour cultivation results as the gold standard. Patients with complicated AA as determined by the surgeon, received a three-day course of oral antibiotics. Postoperative infectious complications within 30 days after surgery were registered.
RESULTS: From July 2020 to January 2021, 101 patients were included. The intraoperative diagnosis was complicated AA in 34 cases. Of these patients, six (17.6%) had bacteria cultured within 24 h after surgery, leading to a sensitivity of 60% and a specificity of 100%. The positive and negative predictive values were 1.00 and 0.96, respectively. Seven patients developed a postoperative infection (five superficial wound infections and two intra-abdominal abscess). In all cases with a positive cultivation result, the intraoperative diagnosis was complicated appendicitis and a postoperative course of antibiotics prescribed.
CONCLUSIONS: Twenty-four-hour cultivation of the peritoneal fluid in acute appendicitis is a valid indicator for peritoneal bacterial contamination. Randomized studies are necessary to determine if this approach is suitable for targeting postoperative antibiotic treatment as a means to prevent overtreatment without increasing the risk of infectious complications.
METHODS: Patients older than 18 years undergoing laparoscopic appendectomy were prospectively enrolled at two surgical departments after informed consent was obtained. Periappendicular fluid was collected prior to appendectomy and sent for cultivation. Sensitivity, specificity and positive and negative predictive values were calculated with 95% confidence intervals (CIs) using 72-hour cultivation results as the gold standard. Patients with complicated AA as determined by the surgeon, received a three-day course of oral antibiotics. Postoperative infectious complications within 30 days after surgery were registered.
RESULTS: From July 2020 to January 2021, 101 patients were included. The intraoperative diagnosis was complicated AA in 34 cases. Of these patients, six (17.6%) had bacteria cultured within 24 h after surgery, leading to a sensitivity of 60% and a specificity of 100%. The positive and negative predictive values were 1.00 and 0.96, respectively. Seven patients developed a postoperative infection (five superficial wound infections and two intra-abdominal abscess). In all cases with a positive cultivation result, the intraoperative diagnosis was complicated appendicitis and a postoperative course of antibiotics prescribed.
CONCLUSIONS: Twenty-four-hour cultivation of the peritoneal fluid in acute appendicitis is a valid indicator for peritoneal bacterial contamination. Randomized studies are necessary to determine if this approach is suitable for targeting postoperative antibiotic treatment as a means to prevent overtreatment without increasing the risk of infectious complications.
摘要：
背景：复杂和不复杂的急性阑尾炎（AA）之间的区别很重要，因为它可以指导术后抗生素治疗。基于术中发现的诊断是不精确的，并且腹膜液的标准培养通常很耗时，几乎没有临床益处。这项研究的目的是检查急性阑尾炎中腹膜液的培养是否可以在24小时内可靠地检测细菌。
方法：接受腹腔镜阑尾切除术的18岁以上患者在获得知情同意后在两个外科部门进行前瞻性招募。在阑尾切除术之前收集阑尾周围的液体并送去培养。灵敏度,以72小时培养结果作为金标准,以95%置信区间(CI)计算特异性和阳性及阴性预测值.由外科医生确定的复杂AA患者，接受了为期三天的口服抗生素治疗。记录术后30天内的感染并发症。
结果：从2020年7月至2021年1月，共纳入101例患者。术中诊断为复杂AA34例。在这些病人中,6人(17.6%)在术后24小时内培养细菌，导致60%的灵敏度和100%的特异性。阳性预测值和阴性预测值分别为1.00和0.96。7例患者发生术后感染（5例浅表伤口感染和2例腹内脓肿）。在所有具有阳性培养结果的情况下，术中诊断为复杂性阑尾炎，术后使用抗生素。
结论：急性阑尾炎腹膜液培养24小时是腹膜细菌污染的有效指标。有必要进行随机研究，以确定这种方法是否适合针对术后抗生素治疗，以防止过度治疗而不增加感染并发症的风险。
方法：接受腹腔镜阑尾切除术的18岁以上患者在获得知情同意后在两个外科部门进行前瞻性招募。在阑尾切除术之前收集阑尾周围的液体并送去培养。灵敏度,以72小时培养结果作为金标准,以95%置信区间(CI)计算特异性和阳性及阴性预测值.由外科医生确定的复杂AA患者，接受了为期三天的口服抗生素治疗。记录术后30天内的感染并发症。
结果：从2020年7月至2021年1月，共纳入101例患者。术中诊断为复杂AA34例。在这些病人中,6人(17.6%)在术后24小时内培养细菌，导致60%的灵敏度和100%的特异性。阳性预测值和阴性预测值分别为1.00和0.96。7例患者发生术后感染（5例浅表伤口感染和2例腹内脓肿）。在所有具有阳性培养结果的情况下，术中诊断为复杂性阑尾炎，术后使用抗生素。
结论：急性阑尾炎腹膜液培养24小时是腹膜细菌污染的有效指标。有必要进行随机研究，以确定这种方法是否适合针对术后抗生素治疗，以防止过度治疗而不增加感染并发症的风险。
