Clinical Features And Etiological Analysis Of Acute Appendicitis In Children

Objective:The clinical data of this paper of acute appendicitis were analyzed,through a retrospective survey method, and the clinical features and etiology data were summarized, which provide a reference for improving the early diagnosis of appendicitis and therapeutic effect in infants and the rational use of antibacterial drugs in children with acute appendicitis.Methods:The medical records of children with acute appendicitis between January 2012 to January 2014 were reviewed.Data including clinical features, diagnosis and treatment and etiological information were analyzed and summarized.Results:1.The statistical result of the clinical data of 106 infants with the acute appendicitis,as follows:(1) The mean age of the infants was 2 years and 4 months, the ratio of males to females was 2.31:1.(2) The incidence of vomiting (69.81%), diarrhea (32.08%) was high and prominent,besides the persistent abdominal pain (84.91%) and fever (90.56%).The fixed tenderness (95.28%) was the common sign of the infants, with the high incidence of signs of peritonitis:muscle tension (84.91%), rebound tenderness(79.25%).(3)The positive detection rate of abdominal ultrasonography was 90.29%, the increased peripheral blood leukocytes accounted for 79.25%.(4) The most pathological findings were the purulent (46.23%) and gangrenous (50.94%) appendicitis, the appendiceal perforation rate was 56.60%; there were no significant differences of the incidence among various pathological types of appendicitis in different course (P= 0.544); and there were no significant differences of the perforation rate in different course (P= 0.966).(5) The pus culture positive rate was 91.75%,the first three pathogenic bacteria were Escherichia coli (66.04%), Pseudomonas aeruginosa (9.43%), Streptococcus anginosus (8.49%).(6) The cure rate was 100% after operation,the complication rate was 9.43%, there were adhesive intestinal obstruction, incisional infection, abdominal abscess.B.The statistical result of the clinical data of 608 children with the acute appendicitis,as follows:(1) There were three types of the acute appendicitis; simple,suppurative and gangrenous appendicitis in this group,in which one single kind bacterial infection has 1 case,63 cases,13 cases;two kinds 0 case,26 cases,62cases;and 1case of gangrenous appendicitis for three kinds,though the comparison between pathological types appendicitis and bacterial infection types there was no significant difference(P>0.05).(2) 493 cases of bacterial samples detected pathogens 296 cases, the positive rate was 60.04,isolated bacteria 386, gram negative bacteria,341(88.34%), gram positive bacteria 45(11.66%); ESBLs producing strains detected in total 126(32.64%).(3) The top three gram negative bacteria and gram positive bacteria were Escherichia coli(65.28%), Pseudomonas aeruginosa(12.18%), Comamonas testosteroni(5.44%)and Streptococcus anginosus(5.18%),Streptococcus constellatus(3.11%), Enterococcus raffinosus(0.78%).(4) The sensitive rates of Escherichia coli, Pseudomonas aeruginosa, Comamonas testosteroni to piperacillin/tazobactam and imipenem(tienam), meropenem and amikacin≥88.1%;the resistance rates of them to ampicillin, tetracycline, cotrimoxazole>61.9%.(5) The treatment program of the acute appendicitis was ceftizoxime sodium+piperacillin/tazobactam sodium+metronidazole or ornidazole,the infectional rate of three types were 100%、97%、97%.Conclusion:(1) There were no specific clinical manifestations and auxiliary examinations in infants with appendicitis.The rate of perforations and complications is still high.Early diagnosis and timely surgery and the use of antibiotics are the keys to increase the cure rates and lower complications. (2) The main pathogens are gram-negative bacteria for children appendicitis, the most common bacteria is Escherichia coli,lt has significant resistance for the broad-spectrum penicillins, cephalosporins; so we should strengthen the clinical detection for pathogens and drug susceptibility test, select antibacterial drugs according laboratory results, reduce drug-resistant strains.