儿科复杂尾炎:在三级医疗中心标准化抗生素方案的结果
Estelle Studer1, Carla Flament-Viricel1, Ana M Calinescu2
1Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
Journal of pediatric surgery
|December 10, 2025
概括
七分之一患有复杂尾炎的儿童需要转换抗生素. 高CRP和预测需要Piperacillin/Tazobactam (PT) 而不是Ceftriaxone/Metronidazole (CM) 的需要.
科学领域:
- 儿科手术 儿科手术
- 传染性疾病 传染性疾病
- 临床药房 临床药房
背景情况:
- 儿科复杂尾炎 (CA) 的标准治疗包括尾切除和静脉注射抗生素.
- 塞夫特里亚克森/美特罗尼达 (CM) 是推的第一线抗生素,如果发烧在术后持续下去,建议切换为皮佩拉西林/塔佐巴克坦 (PT).
- 目前,发烧是调整抗生素治疗方案的唯一标准.
研究的目的:
- 确定CA儿童从CM切换到PT的预测因素.
- 评估使用PT作为预先一线治疗来减少住院时间的潜在好处.
主要方法:
- 在2013年至2023年期间,对256名儿童 (0-16岁) 进行了AC治疗的回顾性分析.
- 将需要转换抗生素的患者与不需要转换抗生素的患者进行比较.
- 分析包括人口统计,病史,生物标志物,成像和手术发现.
主要成果:
- 在256名患者中,有15% (39名) 需要转换抗生素治疗.
- 多变量逻辑回归确定了高的手术前C反应蛋白 (CRP) 水平 (p=0.021) 和腹部内 (p<0.001) 作为切换的显著预测因素.
- 没有其他变量与转换抗生素的需要有显著的关联.
结论:
- 大约15%的儿科CA病例需要从CM切换到PT.
- 术前CRP升高和腹内的存在是需要PT的关键指标.
- 这些发现表明,具有这些指标的儿童可能会从初始PT治疗中受益.
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