지역사회획득 천공성 충수염의 세균학, 항생제 감수성, 경험적 항생 제에 대한 연구 (Bacteriology, Antibiotic Susceptibility and Empirical Antibiotics of Community-acquired Perforated Appendicitis)

서지정보

· 발행기관 : 대한감염학회
· 수록지 정보 : Infection and Chemotherapy / 44권 / 6호 / 439 ~ 445페이지
· 저자명 : 주형욱, 이현성, 김재희, 전재완, 김규열, 정윤성, 전재범

초록

Background: The aim of this study was to study bacteriology and antibiotic susceptibility in patients with community-acquired perforated appendicitis over a five-year-period.
Materials and Methods: We conducted a retrospective review of the records of adult patients (age ≥18 years) who were diagnosed as having perforated appendicitis at Ulsan University Hospital between January 2007 and December 2011. Patients who had healthcare-associated or hospital-acquired appendicitis were excluded.
Intraoperative specimens submitted to the microbiology laboratory were obtained either by aspiration of pus into a syringe or by use of a swab. Anaerobic bacterial cultures were not performed.
Results: Among 216 adult patients with perforated appendicitis, we analyzed 163culture-positive cases. The overall mortality rate of patients was 0.6% (1/163).
Escherichia coli was the most common pathogen (93/163, 57.0%), followed by Streptococcus spp. (45/163, 27.6%), Pseudomonas aeroginosa (13/163, 7.9%),and Enterococcus spp. (17/163, 10.4%). The susceptibility of E. coli to quinolones (ciprofloxacin or levofloxacin) was 74.1%. The susceptibility of E. coli to amoxicillin/clavulanate, cefoxitin, ceftriaxone, piperacillin/tazobactam, and carbapenem reached 75%, 86%, 90%, 98%, and 100%, respectively. Isolated E. coli , including ESBL producing organism and P. aeroginosa, were highly susceptible to piperacillin/tazobactam. Empirical antibiotics used most commonly were a combination of third generation cephalosporin and metronidazole.
Conclusion: E. coli was the most common pathogen of community-acquired perforated appendicitis, and resistance to quinolone was greater than 25%. We cannot recommend quinolones for use as empirical therapy for treatment of perforated appendicitis.

영어초록

Background: The aim of this study was to study bacteriology and antibiotic susceptibility in patients with community-acquired perforated appendicitis over a five-year-period.
Materials and Methods: We conducted a retrospective review of the records of adult patients (age ≥18 years) who were diagnosed as having perforated appendicitis at Ulsan University Hospital between January 2007 and December 2011. Patients who had healthcare-associated or hospital-acquired appendicitis were excluded.
Intraoperative specimens submitted to the microbiology laboratory were obtained either by aspiration of pus into a syringe or by use of a swab. Anaerobic bacterial cultures were not performed.
Results: Among 216 adult patients with perforated appendicitis, we analyzed 163culture-positive cases. The overall mortality rate of patients was 0.6% (1/163).
Escherichia coli was the most common pathogen (93/163, 57.0%), followed by Streptococcus spp. (45/163, 27.6%), Pseudomonas aeroginosa (13/163, 7.9%),and Enterococcus spp. (17/163, 10.4%). The susceptibility of E. coli to quinolones (ciprofloxacin or levofloxacin) was 74.1%. The susceptibility of E. coli to amoxicillin/clavulanate, cefoxitin, ceftriaxone, piperacillin/tazobactam, and carbapenem reached 75%, 86%, 90%, 98%, and 100%, respectively. Isolated E. coli , including ESBL producing organism and P. aeroginosa, were highly susceptible to piperacillin/tazobactam. Empirical antibiotics used most commonly were a combination of third generation cephalosporin and metronidazole.
Conclusion: E. coli was the most common pathogen of community-acquired perforated appendicitis, and resistance to quinolone was greater than 25%. We cannot recommend quinolones for use as empirical therapy for treatment of perforated appendicitis.

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