关键词: 阑尾炎, 肠穿孔, 儿童, 细菌培养, 药敏试验, 耐药性

Abstract: Background　Drug resistance of bacteria has always been a global problem.The resistance of bacteria related to perforated appendicitis in children to commonly used antibacterial drugs is consistently changing，which influences the therapeutic effect and poses challenges to clinical drug selection.Objective　To explore the transition of bacterial drug resistance in children with perforated appendicitis and analyze the changes of antibacterial drug regimens in order to give advice rationally on clinical antibiotics strategy.Methods　The clinical data of 461 children with perforated appendicitis treated in Ningbo Women and Children's Hospital from January 2013 to December 2018 were retrospectively collected.According to the time they were admitted to the hospital，children were divided into Group 1（G1，from January 2013 to December 2015）（n=214） and Group 2（G2，from January 2016 to December 2018）（n=247）.The results of bacterial culture and drug susceptibility test of abdominal pus from appendicitis surgery，and antibacterial drug regimens were analyzed.Results　Of the 461 patients，451 cases had bacterial cultures of abdominal pus，and 10 cases had no bacterial cultures（the reason was that the perforated appendix pus was too few to collect）.Among the bacterial culture results，the number of detected strains of Escherichia coli，Pseudomonas aeruginosa，and Streptococcus anginosus were the top three in both G1 and G2，accounting for 60.8%（129/212），10.4%（22/212），and 6.1%（13/212）in G1，respectively，and 59.5%（163/274），12.0%（33/274），and 4.7%（13/274）in G2，respectively.The resistance of Escherichia coli to cefazolin，maxipime，and macrodantin in G1 and G2 was statistically significant（P<0.05）.There were no significant differences in the resistance of Escherichia coli to ampicillin sulbactam，aztreonam，gentamicin，cotrimoxazole，ceftriaxone，ampicillin，ciprofloxacin，ertapenem，amikacin，cefotetan，imipenem，tobramycin，piperacillin tazobactam，ceftazidime，and levofloxacin between G1 and G2（P>0.05）.The resistance of Pseudomonas aeruginosa to ampicillin sulbactam，cotrimoxazole，ceftriaxone，and ampicillin in G1 and G2 was statistically significant（P<0.05）.There were no significant differences in resistance of Pseudomonas aeruginosa to cefazolin，ciprofloxacin，cefotetan，macrodantin and imipenem between G1 and G2（P>0.05）.Among the anti-bacterial strategies，the top three in G1 were ceftriaxone sodium+meroxicillin sodium/sulbactam sodium，cefodizime sodium+piperacillin sodium and sulbactam sodium needle+metronidazole sodium chloride，and ceftriaxone sodium+meroxicillin sodium/sulbactam sodium+metronidazole disodium phosphate，while the top three in G2 were ceftazidime+metronidazole disodium phosphate，imipenem/cisastatin sodium+metronidazole disodium phosphate，and cefotiam needle+azlocillin sodium for injection.Compared with the G1，the use of ceftriaxone decreased in G2，while the use of carbapenems（imipenem） increased.Conclusion　The problem of drug resistance of bacteria should not be ignored.Ceftriaxone and other drugs have been questioned as the first choice for empirical antibiotics in the treatment of perforated appendicitis，while imipenem is increasingly being used widely as a third-line drug.The drug susceptibility test result is meaningful for guiding the empirical drug application，as well as the dynamic transition of drug resistance.

Key words: Appendicitis, Intestinal perforation, Child, Bacterial culture, Drug susceptibility test, Drug resistance