지역사회획득 천공성 충수염의 세균학, 항생제 감수성, 경험적 항생 제에 대한 연구
Bacteriology, Antibiotic Susceptibility and Empirical Antibiotics of Community-acquired Perforated Appendicitis
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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.
Abstract
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.
참고문헌 (26)
- Solomkin JS., "Diagnosis and management of complicated intraabdominal infection in adults and children : guidelines by the Surgical Infection Society and the Infectious Diseases Society of America", Clin Infect Dis, 50, pp.133~164 (2010)
- 대한감염학회, "소화기계 감염 진료지침 권고안", Infection and Chemotherapy, 42(6), pp.323~361 (2010), 대한감염학회
- Hsueh PR., "Epidemiology and antimicrobial susceptibility profiles of aerobic and facultative Gram-negative bacilli isolated from patients with intraabdominal infections in the Asia-Pacific region : 2008 results from SMART(Study for Monitoring Antimicrobial Resistance Trends)", Int J Antimicrob Agents, 36, pp.408~414 (2010)
- Bochicchio GV., "In vitro susceptibilities of Escherichia coli isolated from patients with intra-abdominal infections worldwide in 2002-2004, results from SMART(Study for Monitoring Antimicrobial Resistance Trends)", Surg Infect(Larchmt), 7, pp.537~545 (2006)
- Kokoska ER., "The impact of intraoperative culture on treatment and outcome in children with perforated appendicitis", J Pediatr Surg, 34, pp.749~753 (1999)
- Soffer D., "Peritoneal cultures and antibiotic treatment in patients with perforated appendicitis", Eur J Surg, 167, pp.214~216 (2001)
- Wie SH., "Antibiotic sensitivity of the causative organisms and use of antibiotics in women with community-acquired acute pyelonephritis", Korean J Infect Dis, 34, pp.353~359 (2002)
- 임승관, "Change of Antimicrobial Susceptibility among Escherichia coli Strains Isolated from Female Patients with Community-Onset Acute Pyelonephritis", Yonsei Medical Journal, 53(1), pp.164~171 (2012), 연세대학교의과대학
- 송희곤, "최근 5년 사이에 발생한 자발성 세균성 복막염의 임상 양상과 배양 균주 및 항균제 내성 추이", Clinical and Molecular Hepatology, 8(2002), pp.61~70 (2002), 대한간학회
- 주문경, "최근 12년간 발생한 자발성 세균성 복막염의 균주와 항생제 내성의 변화", 대한내과학회지, 75(1), pp.68~76 (2008), 대한내과학회
- 이재원, "복강경 충수절제술로 치료한 급성 충수염의 항생제 감수성 및 세균학적 고찰", 대한외과학회지, 79(5), pp.369~376 (2010), 대한외과학회
- Yun SJ., "Culture-sensitivity test and infectious complication in perforated appendicitis", J Korean Soc Coloproctol, 16, pp.73~77 (2000)
- Ahn IK., "Bacteriologic study and prophylactic antibiotics in the acute and complicated appendicitis", J Korean Surg Soc, 55, pp.235~241 (1998)
- Klevens RM., "Invasive methicillin-resistant Staphylococcus aureus infections in the United States", JAMA, 298, pp.1763~1771 (2007)
- Wilson SE., "A severity score for complicated skin and soft tissue infections derived from phase III studies of linezolid", Am J Surg, 185, pp.369~375 (2003)
- Kim KJ., "A bacteriologic investigation of the acute appendicitis", J Korean Surg Soc, 52, pp.122~127 (1997)
- Guillet-Caruba C., "Bacteriologic epidemiology and empirical treatment of pediatric complicated appendicitis", Diagn Microbiol Infect Dis, 69, pp.376~381 (2011)
- Chan KW., "Evidence-based adjustment of antibiotic in pediatric complicated appendicitis in the era of antibiotic resistance", Pediatr Surg Int, 26, pp.157~160 (2010)
- Plas Hvd., "Microbiological evaluation and antimicrobial treatment of complicated intra-abdominal infections", South Afr J Epidemiol Infect, 27, pp.53~57 (2012)
- DeFrances CJ., "National hospital discharge survey : 2005 annual summary with detailed diagnosis and procedure data", Vital Health Stat, 13, pp.1~209 (2007)
- Solomkin JS., "Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections", Clin Infect Dis, 37, pp.997~1005 (2003)
- Paterson DL., "In vitro susceptibilities of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide : the 2003 Study for Monitoring Antimicrobial Resistance Trends(SMART)", J Antimicrob Chemother, 55, pp.965~973 (2005)
- Solomkin JS., "Ertapenem versus piperacillin", tazobactam in the treatment of complicated intraabdominal infections : results of a doubleblind, randomized comparative phase III trial, 2003, pp.237, 235~245
- Zhang Y., "Determination of posterior lens capsule status in traumatic cataract with B-ultrasonography", Zhonghua Yan Ke Za Zhi, 34, pp.298~299 (1998)
- Gorbach SL., "Clindamycin in pure and mixed anaerobic infections", Arch Intern Med, 134, pp.87~92 (1974)
- Wang Z., "Progress in the technology of medical ultrasonography equipments and current status of the market", Zhongguo Yi Liao Qi Xie Za Zhi, 22, pp.346~349 (1998)