复杂尾炎的抗生素治疗:它可以优化吗?
Yael Dreznik1, Maya Paran1, Efraim Bilavsky2
1Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
The Israel Medical Association journal : IMAJ
|February 29, 2024
概括
对于儿童复杂性尾炎,一般化腹膜炎和高C反应蛋白 (CRP) 水平表明需要更广泛的抗生素治疗,可能是tazobactam/piperacillin (TP),以获得更好的结果.
科学领域:
- 儿科手术 儿科手术
- 传染性疾病 传染性疾病
- 临床药理学 临床药理学
背景情况:
- 复杂尾炎的治疗缺乏针对个性化抗生素治疗的既定指南.
- 目前治疗儿科复杂尾炎的方法需要进一步改进.
研究的目的:
- 确定儿童复杂尾炎初始抗生素选择的特定危险因素.
- 根据患者特定因素优化经验性抗生素治疗方案.
主要方法:
- 对300名儿科患者 (<18岁) 进行复杂尾炎的腹腔镜尾切除术 (2012-2022) 的回顾性分析.
- 评估初始抗生素治疗的塞夫特里亚克松+美特罗尼达 (CM) 和随后的变化,以tazobactam/piperacillin (TP).
主要成果:
- 19% (57/300) 的患者因耐药细菌或临床恶化而需要从CM切换到TP.
- 手术期间的泛周炎和入院时的C-反应蛋白 (CRP) > 20 mg/L是改变饮食方案的重要风险因素.
结论:
- 一般化腹膜炎和CRP水平升高 (>20 mg/L) 是切换到tazobactam/piperacillin (TP) 的强有力的预测因素.
- 对高风险儿科患者进行TP的初始实证治疗可能会改善临床结果并减少住院时间.
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