Publication: Estudio de la flora patógena y resistencias en apendicitis pediátricas
Authors
Fernández Ibieta, María ; Martínez Castaño, I. ; Reyes Ríos, P. ; Cabrejos Perotti, K. ; Rojas Ticona, J. ; Girón Vallejo, Óscar ; Trujillo Ascanio, A. ; Menasalvas Ruiz, Ana Isabel ; Alfayate, S. ; Ruiz Jiménez, J. I.
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Ergon
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info:eu-repo/semantics/article
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Abstract
Objetivos. Existe controversia sobre la utilidad del cultivo de líquido peritoneal en las apendicitis pediátricas. Hemos investigado la situación epidemiológica de la flora bacteriana en las apendicectomías pediátricas. Material y métodos. Revisión retrospectiva de apendicectomías realizadas en menores de 12 años, en dos años (enero/2009-diciembre/ 2010) y análisis prospectivo durante un año (enero/2011-diciembre/ 2011) Resultados. Encontramos 728 pacientes (media 7,1 años, rango 2-11). De ellos, 108 eran <5 años. Se recogió cultivo de líquido peritoneal en 328 (45,1%). Los cultivos fueron positivos en 155 de esas 328 muestras (47,3%). Fue más frecuente encontrar cultivo positivo en <5 años (69,2% vs. 40,4%, p <0,001. OR: 3,3. IC 95%: 1,8-5,9). Las bacterias más habituales fueron Escherichia coli, con 122 aislamientos, Streptococcus spp (50 aislamientos), P. aeruginosa, (45 aislamientos) y B. fragilis (35). La frecuencia de P. aeruginosa fue cinco veces mayor en el grupo de <5 años (30,8% vs. 8,4%, p<0,001. OR: 4,8. IC 95%: 2,3-9,8). Asimismo, la presencia de E. coli se duplicó en el grupo de <5 años (50% vs. 33,2% p = 0,01. OR: 2,01. IC 95%: 1,1-3,4). 26 (21,3%) especímenes de E. coli eran resistentes a amoxicilina-clavulánico. Hubo 15 (12,3%) cepas de E. coli ultirresistentes. 16 cepas de Streptococcus (32%) y 10 aislamientos de B. fragilis (28,6%) fueron resistentes a clindamicina. Conclusiones. En <5 años existe más riesgo de infección por Pseudomonas. Encontramos una alta tasas de resistencia de E. coli a la amoxicilina-clavulánico y 12,3% de E. coli eran multirresistentes.
There is controversy about the convenience of performing a bacteriological peritoneal culture in pediatric appendicitis. We performed a sero-epidemiological survey of the bacteria found in peritoneal swabs from pediatric appendicitis operated in our hospital. Methods. Ambispective study. Retrospective revision of the bacteriological results from peritoneal swabs performed in pediatric appendicitis from january 2009 to december 2010 (2 years) and prospective study of peritoneal swabs collected between january 2011 and december 2011 (one year). Results. We found 728 pediatric patients (mean age 7.1, range: 2-11 years). Among these, 108 were <5 years. Cultures were performed in 328 (45.1%). A positive result was found in 155 swabs, (47.3%). Positive cultures were more frequent in patients <5 years (69.2% vs 40.4%, p <0,001). The most requent pathogens were E. coli: 122 specimens, Streptococcus spp (50 swabs), P. aeruginosa: (45) and B. fragilis: (35) Younger age was strongly associated with P. aeruginosa:(30.8% vs 8.4%, p<0,001. OR: 4.8. IC 95%: 2.3-9.8). So was the detection of E. coli (50% vs 33.2% p=0,01). 21.3% (26 swabs) of E. coli were resistant to amoxicillin-clavulanic acid. There were 15 (12.3%) multiresistant (ESBL) E. coli. Among the Streptococcus, 32% (16 out of 50) were resistant to clindamicin, and so were 28.6% of the B. fragilis (10 out of 35). Discussion. The most frequent pathogens were E. coli, Streptococcus spp and P. aeruginosa. P. aeruginosa is fi ve times more frequent in patients <5 years. Resistance of E. coli to amoxiclavulanate was high: 21.3% of the specimens. We found that 12.3% of the E. coli produced ESBL.
There is controversy about the convenience of performing a bacteriological peritoneal culture in pediatric appendicitis. We performed a sero-epidemiological survey of the bacteria found in peritoneal swabs from pediatric appendicitis operated in our hospital. Methods. Ambispective study. Retrospective revision of the bacteriological results from peritoneal swabs performed in pediatric appendicitis from january 2009 to december 2010 (2 years) and prospective study of peritoneal swabs collected between january 2011 and december 2011 (one year). Results. We found 728 pediatric patients (mean age 7.1, range: 2-11 years). Among these, 108 were <5 years. Cultures were performed in 328 (45.1%). A positive result was found in 155 swabs, (47.3%). Positive cultures were more frequent in patients <5 years (69.2% vs 40.4%, p <0,001). The most requent pathogens were E. coli: 122 specimens, Streptococcus spp (50 swabs), P. aeruginosa: (45) and B. fragilis: (35) Younger age was strongly associated with P. aeruginosa:(30.8% vs 8.4%, p<0,001. OR: 4.8. IC 95%: 2.3-9.8). So was the detection of E. coli (50% vs 33.2% p=0,01). 21.3% (26 swabs) of E. coli were resistant to amoxicillin-clavulanic acid. There were 15 (12.3%) multiresistant (ESBL) E. coli. Among the Streptococcus, 32% (16 out of 50) were resistant to clindamicin, and so were 28.6% of the B. fragilis (10 out of 35). Discussion. The most frequent pathogens were E. coli, Streptococcus spp and P. aeruginosa. P. aeruginosa is fi ve times more frequent in patients <5 years. Resistance of E. coli to amoxiclavulanate was high: 21.3% of the specimens. We found that 12.3% of the E. coli produced ESBL.
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Cirugía Pediátrica, 2014, Vol. 27, N. 1, pp. 16-20
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