Early diagnosis of bacterial contamination of the abdominal cavity with destructive appendicitis in children using the test system «D-lactam»
DOI:
https://doi.org/10.15574/PS.2019.62.25Keywords:
acute destructive appendicitis, peritonitis, D-lactate, pediatric surgery, microorganismAbstract
Objective. To determine the diagnostic value of the test system «D-lactam» for the diagnosis of bacterial contamination of the abdominal cavity in acute destructive appendicitis (ODA) and its purulent complications in children.
Materials and methods. The main group of patients included 48 children with ODA, control – 12, routinely hospitalized in the pediatric surgical department of Vitebsk Regional Clinical Center for Children. In the main group, 34 (70.83%) patients underwent an uncomplicated ODA (subgroup I), and 14 (29.17%) children had ODA complicated by peritonitis (subgroup II). The median of hospital stay was 11 (10-12) bed-days (subgroup I) and 17.5 (14-19) bed-days (subgroup II). The peritoneal exudate (PE) was collected during emergency and planned open and laparoscopic operations for ODA (n=48), inguinal hernia (n=8), varicocele (n=3), abdominal cryptorchidism (n=1). The material was sent for bacteriological analysis and D-lactate. Bacteriological analysis of PE was performed on a Vitek 2 CompactBiomerieux microbiological analyzer (France). Statistical analysis was carried out in the program Statistica 10.0, SPSS 19 and MedCalc 10.2.
Results. The level of D-lactate in PE in 48 patients of the main group was 1.21 (0.58–2.85) mmol/l (min 0.19 mmol/l – max 4.89 mmol/l). The median of D-lactate concentration of PE in the control group was 0.26 (0.2–0.31) mmol/l (min 0.16 mmol/l – max 0.34 mmol/l), which is statistically significant (U-test Mann–Whitney, p<0.0001) exceeds that in patients with ODA. During the ROC analysis, it was found that the level of D-lactate in PE exceeding 0.335 mmol/l indicates that the patient has bacterial contamination with a sensitivity of 89.6% (95% CI: 77.3…96.5) and specificity 100% (95% CI: 73.5…100), the field area under the curve AUC=0.938 (95% CI: 0.872 … 0.996) (p<0.001), which makes it possible to consider determining the level of D-lactate in PE as a good method of express diagnosis of bacterial infections of the abdominal cavity.
Conclusions. The use of the «D-Lactam» test system with the determination of D-lactate in PE exceeding 0.335 mmol/l reliably (p<0.001) indicates the presence of bacterial contamination of the abdominal cavity in patients with ODA.
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