Study on the correlation between abdominal infection and psychological stress in children based on nucleic acid detection

Abstract

BACKGROUND

Diagnosing and treating abdominal infection in children remains a challenge. Nucleic acid detection, as a rapid and accurate diagnosis tool, has great significance in this field.

AIM

To investigate the diagnosis and treatment of abdominal infection by nucleic acid detection and its possible correlation with psychological stress in children.

METHODS

A total of 50 pediatric patients diagnosed with abdominal infections between September 2020 and July 2021 were included in this study. Intra-abdominal pus samples were collected for pathogen culture, drug susceptibility testing, and broad-spectrum bacterial nucleic acid testing. Psychological stress, anxiety, depression, and coping styles were assessed using the coping with a disease (CODI) scale.

RESULTS

Based on susceptibility testing, a regimen of cefazoxime, piperacillin/tazobactam, and metronidazole or ornidazole achieved 100% effectiveness in treating appendicitis. Psychological assessments revealed a positive correlation between pressure level and both anxiety (r = 0.324, P = 0.001) and depressive disorders (r = 0.325, P < 0.001). Acceptance and distancing as coping strategies were negatively correlated with anxiety and depression, while negative emotional responses were strongly associated with increased anxiety (r = 0.574, P < 0.001) and depression (r = 0.511, P = 0.001). Coping strategies such as illusion and escape showed no significant correlation with emotional outcomes.

CONCLUSION

Nucleic acid testing helps in the diagnosis of abdominal infections in children, and also focuses on children's mental health.

Key Words: Broad-spectrum bacterial nucleic acid detection; Children; Abdominal infection; Diagnosis and treatment; Psychological stress

Core Tip: To investigate the diagnosis and treatment of abdominal infection by nucleic acid detection and its possible correlation with psychological stress in children. After the study, we concluded that in clinical practice, nucleic acid detection can effectively assist the diagnosis and treatment of abdominal infection in children, and some patients show different degrees of anxiety or other psychological stress reactions when receiving nucleic acid detection. The study underscores the psychological impact of abdominal infections on children, revealing significant associations between perceived stress, anxiety, depression, and coping mechanisms. Promoting adaptive coping strategies like acceptance and distancing could help reduce the emotional distress experienced by these patients.

INTRODUCTION

Pediatric abdominal infections refer to bacterial, viral or fungal infections occurring in the abdominal cavity of children, potentially involving organs such as the liver, pancreas, and intestines[1]. These infections can have serious consequences, including fever, nausea, vomiting, abdominal pain, and, in severe cases, may lead to sepsis and multiple organ dysfunction syndrome[2,3]. Prolonged untreated abdominal infections can also result in malnutrition, growth retardation, weakened immunity, and other complications, severely impacting the child's health and quality of life[4]. Therefore, timely diagnosis and effective treatment of pediatric abdominal infections are essential to minimize their adverse effects on children's health[5].

Currently, the prevention and treatment of bacterial infections in children rely primarily on the use of antimicrobial drugs. However, the selection of antimicrobials, particularly during postoperative treatment, is often empirical, which can lead to inappropriate medication choices, increasing the risk of antimicrobial resistance and affecting treatment efficacy. Rapid and accurate identification of pathogenic bacteria is crucial for selecting effective treatment options[6]. Traditional methods of pathogen detection and antimicrobial susceptibility testing, commonly used in clinical practice, are time-consuming, often delaying appropriate therapeutic measures and necessitating empirical antibiotic use.

Broad-spectrum bacterial nucleic acid detection, based on bacterial 16S rRNA sequence analysis, has emerged as one of the most effective methods for identifying and classifying bacteria[7]. This technique allows for earlier, more rapid, and sensitive diagnosis of bacterial infections, providing guidance for timely and effective antibiotic therapy, and thus improving treatment outcomes. In this study, we developed a 16S rRNA sequence-based method for efficient, sensitive, and unbiased amplification to support postoperative surveillance of abdominal infections caused by bacterial pathogens in children.

Additionally, previous studies have indicated that children may experience psychological stress during medical examinations, including nucleic acid testing, but systematic investigation and analysis of these responses are lacking[8]. Therefore, this study not only explores the application of nucleic acid testing in diagnosing and treating pediatric abdominal infections but also provides a preliminary analysis of its potential psychological impacts, integrating psychological theory for further understanding[9,10].

MATERIALS AND METHODS

General information

This study included 50 pediatric cases of abdominal infection treated from September 2020 to July 2021. Intra-abdominal pus samples were collected for pathogen culture, drug susceptibility testing, and broad-spectrum bacterial nucleic acid testing. The diagnosis of abdominal infection was based on clinical symptoms, signs, auxiliary examinations, and surgical findings. Among the 50 cases, 37 (75%) were diagnosed with appendicitis, 4 cases (8%) with intestinal obstruction, intussusception, intestinal perforation 2 cases (4%) with Meckel’s diverticulum, and 7 cases (14%) with digestive tract malformation, perforation, and tumor. The inclusion criteria were as follows children aged 1 to 14 years, informed consent form the child's family members, and postoperative abdominal infection characterized by fever, abdominal pain, abdominal distension, and elevated white blood cell count within a few days after appendectomy, confirmed by B-ultrasound and auxiliary examinations. Children with acute simple appendicitis, those who had not undergone abdominal surgery, those with language dysfunction, and those with other complicated diseases were excluded from the study.

Bacterial detection methods

The cases were randomly divided into an observation group and control group. In the observation group, blood samples were collected for nucleic acid testing, while pus or exudate samples were collected for bacterial culture and drug sensitivity testing during surgery. All children were diagnosed with acute abdomen and required emergency surgical intervention. Broad-spectrum bacterial detection was performed using the following steps: (1) Bacterial genome extraction; (2) Amplification of 16S rDNA sequences using specific primers; (3) Purification of PCR products; (4) Sequencing of 16S rDNA; (5) Comparison of sequence data with known bacterial species in a reference database, and (6) Construction of a phylogenetic tree. During surgery, purulent exudate (1-2 mL) or necrotic tissue (1-2 g) from the deep abdominal infection site was collected and placed in a sterile tube. Samples were sent to the bacterial laboratory for aerobic culture within 2 hours using the Vitek32 automatic microbial identification and susceptibility system, following Clinical and Laboratory Standards Institute/National Committee for Clinical Laboratory Standards (NCCLS) guidelines. Relevant clinical data of the children were also collected.

Observational indicators strain isolation and identification: Once intraperitoneal fluid seepage was observed during surgery, 1-2 mL of purulent fluid was extracted from the abdominal cavity using a sterile syringe. The sample was immediately injected into a sterile test tube and sent to the laboratory within 1 hour for bacterial culture. Pathogens were isolated in accordance with standard laboratory protocols.

Drug sensitivity test: Drug susceptibility testing was performed using the slide diffusion method. Results were interpreted strictly according to the guidelines set by the NCCLS.

Psychological stress and coping assessment

Psychological stress, anxiety, depression, and coping mechanisms were assessed using the coping with a disease (CODI) scale, a self-assessment tool designed for children with chronic diseases. The CODI scale has demonstrated good reliability and validity, and it evaluates multiple psychological dimensions:

Anxiety disorder: Anxiety levels were measured using the anxiety subscale of the CODI scale.

Depressive disorder: Depression levels were measured using the depressive disorder subscale of the CODI scale.

Stressors: Pressure level was assessed as a key variable representing the level of stress perceived by the children.

Coping styles: Coping strategies were evaluated across the following domains: (1) Acceptance: Coping by accepting the disease or condition; (2) Distancing: Coping by emotionally distancing from the stressor; (3) Negative emotional response: Coping characterized by expressions of negative emotions such as anger or frustration; (4) Illusion: Coping through unrealistic or fantasy-based thoughts about the disease or stressor; and (5) Escape: Coping by avoiding or attempting to escape from the reality of the situation.

Statistical analysis

Statistical analyses were performed using SPSS 22.0 software. To evaluate the relationships between psychological factors (e.g., anxiety, depression) and stressors or coping styles, Pearson correlation coefficients were calculated. Specifically: The relationship between anxiety disorder and pressure level, as well as the various coping styles (acceptance, distancing, negative emotional response, illusion, and escape), was assessed.

The relationship between depressive disorder and these same variables (pressure level and coping styles) was also analyzed. A correlation coefficient (r) with an associated P value was used to determine the strength and significance of these associations. All results were considered statistically significant at P < 0.05.

RESULTS

Among 50 children with abdominal infection, 37 cases (75%) were diagnosed with appendicitis, 4 cases (8%) with intestinal obstruction, intussusception, or intestinal perforation, and 2 cases (4%) with Meckel's diverticulum. Additionally, 7 cases (14%) involved digestive tract malformations, perforations, or tumors (Table 1).

Table 1 Distribution of abdominal infections diagnoses in 50 pediatric cases.

Diagnosis	Number of cases (n)	Percentage (%)
Appendicitis	37	75
Intestinal obstruction, intussusception, or intestinal perforation	4	8
Meckel's diverticulum	2	4
Digestive tract malformations, perforations, or tumors	7	14

The incidence of intraoperative primary acute appendicitis was as high as 70%. Among the 50 children, 41 tested positive for bacterial infection, yielding a detection rate of 82%, with 58 pathogenic bacteria isolated. The most common bacterial pathogens identified were Escherichia coli (E. coli) and Enterococcus (Table 2).

Table 2 Types of pathogens detected.

Pathogen	Number of strains	Percentage (%)
Escherichia coli	32	55.17
Klebsiella pneumoniae	2	3.44
Pseudomonas aeruginosa	4	6.89
Other	5	8.62
Enterococcus	8	13.79
Staphylococcus	4	6.89
Other	3	5.17
Total	58	100

Extended-spectrum beta-lactamase (ESBL)-producing bacteria demonstrated significantly higher resistance to various antibiotics compared to non-ESBL-producing strains. The resistance rates of non-ESBL-producing E. coli to carbapenems, cefoxitin, and cefoperazone/sulbactam were 0%, 23.4% and 27.7%, respectively. No resistance to vancomycin or teicoplanin was observed in Staphylococcus and Enterococcus strains. Based on bacterial culture and susceptibility testing, the recommended antibiotic regimen included cefazoxime, piperacillin/tazobactam, and metronidazole or ornidazole. The anti-infective treatment using this regimen achieved 100% effectiveness in cases of appendicitis (Table 3).

Table 3 Antibiotic resistance rates of bacteria.

Bacteria/antibiotic	Resistance rate (%)
Non-ESBL-producing E. coli (carbapenems)	0
Non-ESBL-producing E. coli (cefoxitin)	23.4
Non-ESBL-producing E. coli (cefoperazone/sulbactam)	27.7
Staphylococcus/Enterococcus (vancomycin)	0
Staphylococcus/Enterococcus (teicoplanin)	0

ESBL: Extended-spectrum beta-lactamase; E. coli: Escherichia coli.

Table 4 demonstrates the significant relationships between children's anxiety, depressive disorders, and their perceived stressors and coping styles. The pressure level showed a positive correlation with both anxiety (r = 0.324, P = 0.001) and depressive disorders (r = 0.325, P < 0.001), indicating that higher perceived stress was associated with increased levels of both anxiety and depression. In contrast, coping styles such as acceptance and distancing were negatively correlated with anxiety (r = -0.236, P = 0.001; r = -0.201, P = 0.002, respectively) and depression (r = -0.306, P < 0.001; r = -0.218, P = 0.001), suggesting that these coping mechanisms may reduce emotional distress in children. However, negative emotional response was strongly positively correlated with both anxiety (r = 0.574, P < 0.001) and depressive disorders (r = 0.511, P = 0.001), implying that children who exhibit more negative emotions tend to experience higher levels of anxiety and depression. Interestingly, coping styles such as illusion and escape did not show significant associations with either anxiety or depression, indicating that these strategies may have limited impact on emotional outcomes in this population.

Table 4 The relationship between children's anxiety, depression disorders and their stressors and coping styles.

Variables	Anxiety disorder		Depressive disorder
	r	P value	r	P value
Pressure level	0.324	0.001	0.325	< 0.001
Coping style
Acceptance	-0.236	0.001	-0.306	< 0.001
Distancing	-0.201	0.002	-0.218	0.001
Negative emotional response	0.574	< 0.001	0.511	0.001
Illusion	0.004	0.924	-0.053	0.741
Escape	0.038	0.591	-0.147	0.581

DISCUSSION

Through the application of broad-spectrum bacterial infection nucleic acid detection in the treatment of abdominal infection in children, it provides a rapid and accurate method for screening bacteria, so that patients can be timely given the correct antibiotic drug treatment[11]. This technology can not only identify bacteria that cannot be detected by conventional blood culture, but also realize the rapid and accurate classification, identification and detection of pathogenic bacteria[12]. It can also be caused by a suspected infectious disease and has been treated with antibacterial drugs. Thus, the incidence of bacterial resistance can be reduced, the treatment cycle can be shortened, the treatment cost can be reduced, and the anxiety and psychological pressure of patients can be relieved[13]. The results of pus culture showed that there were more gram-negative bacteria than gram-positive bacteria among the 58 pathogens detected, which may be related to acute appendicitis as the main primary cause of intraperitoneal infection[14]. The pathogenic bacteria of peritoneal infection are related to the origin of the disease, the pathogenic bacteria of appendicitis mostly come from the normal flora in the intestine, and Escherichia coli is the most common. The resistance rate of ESBLS-producing strains to multiple antibiotics was significantly higher than that of non-enzyme producing strains. In addition to imipenem and meropenem, piperacillin/tazobactam, cefoxitin and amicacin also had certain antibacterial activity, while other second and third generation cephalosporins and amtraxam were all resistant[15,16]. This can also explain the reasons why the children with ESBLS-producing strains detected in peritoneal infection pus culture are often more serious, the course of the disease is prolonged, and the complications such as incision infection and abdominal residual abscess are relatively more. Therefore, in order to achieve better clinical results, timely detection of ESBLS-producing bacteria is very necessary for clinical treatment. "Stress", also known as stress or tension, is a state of tension involving both physical and mental aspects[17]. "Stressors", also known as stressors or stressors, are irritants that require the body to adapt and cope, and thus lead to physiological and psychological reactions full of tension[18,19]. In clinical practice, nucleic acid detection can effectively assist the diagnosis and treatment of abdominal infection in children[20]. In addition to the physical health outcomes, this study also explored the psychological impact of abdominal infections on pediatric patients. The findings showed a significant positive correlation between the pressure level and both anxiety and depressive disorders. Children who experienced higher levels of perceived stress exhibited higher levels of anxiety and depression. Conversely, coping strategies such as acceptance and distancing were found to be protective, showing negative correlations with both anxiety and depression. These findings suggest that teaching children more adaptive coping strategies could be a valuable intervention for reducing the psychological burden associated with abdominal infections.

On the other hand, negative emotional responses were strongly correlated with increased anxiety and depression, indicating that children who react with frustration or anger to their illness are more likely to experience adverse psychological outcomes. Interestingly, coping mechanisms such as illusion and escape were not significantly associated with either anxiety or depression, suggesting that these coping styles may have limited utility in managing psychological stress in this population. This points to the need for interventions that foster more constructive coping mechanisms, such as acceptance and distancing, to mitigate the psychological impact of illness.

The rise of multidrug-resistant bacteria poses significant challenges in clinical treatment, as evidenced by the increasing resistance rates observed in this study. As a result, even common infections now carry the potential to become life-threatening, complicating the management of conditions like appendicitis and other abdominal infections. It is therefore critical to rapidly identify the causative pathogens and to administer the most effective antibiotics as early as possible. This study underscores the importance of both precision in diagnosis and the need for robust antibiotic stewardship programs to combat the threat of antimicrobial resistance.

CONCLUSION

The application of broad-spectrum bacterial nucleic acid detection in the treatment of abdominal infections in children provides a rapid and accurate method for bacterial screening, allowing for timely and appropriate antibiotic treatment. This technology not only identifies bacteria that are undetectable by conventional blood cultures but also facilitates the rapid and precise classification, identification and detection of pathogenic bacteria, even in cases where patients have already received antibacterial therapy. Consequently, this approach can help reduce bacterial resistance, shorten treatment duration, lower healthcare costs, and alleviate patients' anxiety and psychological stress. The study demonstrates that abdominal infections in children, particularly appendicitis, are common and can be effectively treated with a targeted antibiotic regimen, provided appropriate bacterial culture and susceptibility testing are conducted. The findings also highlight the significant psychological burden these infections can place on pediatric patients, emphasizing the need for comprehensive treatment approaches that address both physical and emotional well-being. Finally, this study reinforces the urgency of addressing antimicrobial resistance through appropriate antibiotic use and timely interventions.