Improving treatment plan and mental health in children with abdominal infection for broad-spectrum bacterial infections

Abstract

BACKGROUND

Pediatric abdominal infection is a common but serious disease that requires timely and effective treatment. In surgical treatment, accurate diagnosis and rational application of antibiotics are the keys to improving treatment effects.

AIM

To investigate the effect of broad-spectrum bacterial detection on postoperative antibiotic therapy.

METHODS

A total of 100 children with abdominal infection who received surgical treatment in our hospital from September 2020 to July 2021 were grouped. The observation group collected blood samples upon admission and sent them for broad-spectrum bacterial infection nucleic acid testing, and collected pus or exudate during the operation for bacterial culture and drug sensitivity testing; the control group only sent bacterial culture and drug sensitivity testing during the operation.

RESULTS

White blood cell count, C-reactive protein, procalcitonin, 3 days after surgery, showed better postoperative index than the control group (P < 0.05). The hospital stay in the observation group was significantly shorter than that in the control group. The hospitalization cost in the observation group was significantly lower than that in the control group, and the difference between the two groups was statistically significant (P < 0.05).

CONCLUSION

Early detection of broad-spectrum bacterial infection nucleic acids in pediatric abdominal infections can help identify pathogens sooner and guide the appropriate use of antibiotics, improving treatment outcomes and reducing medical costs to some extent.

Key Words: Pediatric abdominal infection; Nucleic acid detection of broad-spectrum bacterial infection; Bacterial culture; Drug sensitivity testing; Treatment effect; Cost; Mental health

Core Tip: Preliminary nucleic acid detection of broad-spectrum bacterial infections has important clinical significance in the surgical treatment of abdominal infections in children. The results of this study show that compared with only intraoperative bacterial culture + drug sensitivity testing, early broad-spectrum bacterial infection nucleic acid testing can significantly improve patients' treatment effects, mental health and recovery quality, and reduce medical costs. First of all, conducting broad-spectrum bacterial infection nucleic acid detection in advance can help identify pathogens earlier and guide the rational use of antibiotics, thereby effectively controlling the development of infection. The postoperative infection indicators of the patients in the observation group were significantly lower than those of the control group, and the hospitalization time and costs were also significantly reduced, which further verified the clinical value of nucleic acid testing in advance. This research result has guiding significance for clinical practice and also provides an important reference for future related research.

INTRODUCTION

Infectious diseases caused by pathogenic bacteria pose a serious threat to human health, and a large amount of medical and health resources are invested in the prevention and treatment of bacterial infections[1,2]. At present, the prevention and control of pathogenic infections mainly rely on the use of antibacterial drugs[3,4]. However, with the abuse of antimicrobials in aquaculture and other fields and the irrational use of medical institutions, the susceptibility of pathogenic bacteria to antimicrobials is increasing[5,6]. The gradual decrease and emergence of multi-drug resistant bacteria have brought great difficulties to clinical treatment. Any common infection and minor trauma can be pathogenic[7,8]. In pediatric medicine, abdominal infections are a common but serious condition that can be caused by bacteria, viruses, or fungi[9,10]. It usually presents with abdominal pain, fever, abdominal tenderness and other symptoms. In severe cases, it can lead to complications such as peritonitis, abscesses, and even sepsis, threatening the life of the child[11,12]. Early diagnosis and timely and effective treatment of abdominal infection in children are essential. Traditionally, the diagnosis of abdominal infection mainly relies on clinical manifestations, imaging examination and bacterial culture[13,14]. However, these methods have certain limitations, such as lack of specificity of clinical manifestations, uncertain imaging results, and long bacterial culture time, leading to delayed diagnosis and treatment, increasing the risk of disease, and patients suffering from physical and mental torture[15]. With the development of molecular biology and biotechnology, broad-spectrum bacterial infection nucleic acid detection as an emerging diagnostic technology[16,17] has gradually attracted people's attention. 16Sr RNA DNA sequence determination has been used for bacterial typing and identification, which can diagnose bacterial infection earlier, faster and more sensitively[18,19]. In recent years, researchers at home and abroad have used a variety of molecular biological methods to study bacterial 16S rDNA and obtained a wide range of bacterial 16S rDNA sequence libraries. It can be used to detect bacteria that cannot be cultured or grow slowly in the gut. The sequence analysis has become an ideal tool for bacterial classification, detection and evaluation of species relationships[20,21].

Based on the above background, the purpose of this study was to investigate the therapeutic efficacy, cost and mental health improvement of patients with early broad-spectrum bacterial infection nucleic acid detection and only intraoperative bacterial culture + drug sensitivity test in pediatric abdominal infection surgery. By comparing the clinical application of two different detection strategies, the aim is to provide a more scientific and effective reference for the diagnosis and treatment of abdominal infection in children, and provide a basis for improving the treatment experience and quality of life of patients.

MATERIALS AND METHODS

Normal information

This study retrospectively collected case data of children who underwent surgical treatment of abdominal infections in our hospital from September 2020 to July 2021 (Table 1). All cases underwent surgical treatment in the Department of Pediatrics of our hospital during this period. The patient's clinical data includes but is not limited to age, gender, chief complaint, past medical history, surgical method, surgical indications, complications, length of stay, cost.

Table 1 Comparison of general information between the two groups of patients.

Index	Observation group	Control group	t/χ²	P value
Average age (years)	5.8 ± 2.3	6.2 ± 2.5	1.32	0.188
Gender (male/female)	55/45	60/40	0.54	0.462
Chief complaint (abdominal pain/fever/nausea and vomiting)	Abdominal pain: 40; Fever: 30; Nausea and vomiting: 20; Diarrhea: 5; Others: 5	Abdominal pain: 45; Fever: 25; Nausea and vomiting: 15; Diarrhea: 10; Others: 5	2.12	0.713
Surgical method (open/laparoscopic)	70/30	65/35	0.95	0.329
Pain score on admission (0-10)	6.2 ± 1.8	6.5 ± 1.6	0.92	0.362
Family environment score (0-100 points)	78.5 ± 5.2	76.8 ± 6.4	1.54	0.124

Research design

This study was a retrospective cohort study. Through retrospective collection and analysis of case data, we compared the differences in treatment effects, costs, and mental health improvement between two groups of patients who underwent broad-spectrum bacterial infection nucleic acid assay, bacterial isolation, and drug susceptibility assay, and those who only underwent intraoperative bacterial culture + drug sensitivity testing.

Inclusion and discharge standards

Inclusion criteria: Pediatric patients older than 3 months; clinical manifestations consistent with the symptoms and signs of abdominal infection; abdominal infection confirmed by auxiliary examination, and surgical treatment is required due to the condition; patients and parents sign a contract with the hospital ethics committee and are informed Consent form; no history of antibiotic use before surgery.

Exclusion criteria: Patients younger than 3 months old; patients who have received antibiotic treatment before surgery; patients with other comorbidities who require emergency surgical treatment; unable to obtain informed consent signed by patients and parents; patients with severe cardiovascular and hepatic diseases Patients with underlying diseases such as renal insufficiency or low immune function.

Grouping situation

The study divided patients into observation groups and control groups based on different testing strategies. Patients in the observation group underwent broad-spectrum bacterial infection nucleic acid testing upon admission, and underwent bacterial culture + drug sensitivity testing during surgery. while patients in the control group only underwent bacterial culture + drug sensitivity testing during surgery.

Interventions

Patients in the observation group underwent broad-spectrum bacterial infection nucleic acid testing immediately after admission. At the same time, pus or exudate was collected during the operation and sent for bacterial culture and drug sensitivity. Patients in the control group only underwent bacterial culture + drug sensitivity testing during surgery.

Observation indicators

Infection indicators: Including changes in white blood cell count, C-reactive protein, procalcitonin and other infection indicators.

Mental health measures: Including changes in anxiety and depression scores.

Statistical analysis

SPSS 25.0 software was used for statistical analysis of data. Continuous variables were described by mean ± SD, and t test or analysis of variance was used for comparison between groups. Categorical variables were described by frequency (percentage), and the χ² test was used for comparison between groups. A P value < 0.05 was considered statistically significant.

RESULTS

Preoperative infection indicators

There was no significant difference between the observation group and the control group in terms of preoperative white blood cell count, C-reactive protein, procalcitonin and other infection indicators (P > 0.05). The indexes in the postoperative observation group were significantly better than those in the control group, The difference between the two groups was statistically significant (P < 0.05; Table 2).

Table 2 Preoperative infection indicators.

Index	Observation group	Control group	t value	P value
White blood cell count (× 109/L)	10.38 ± 2.31	11.51 ± 2.63	-3.22	< 0.05
C-reactive protein (mg/L)	34.87 ± 8.26	42.57 ± 10.2	-5.86	< 0.05
Procalcitonin (ng/mL)	18.6 ± 4.46	21.7 ± 4.72	-4.77	< 0.05

Postoperative infection indicators

On the 3^rd day after surgery: The white blood cell count of the observation group was 8.55 × 10⁹ ± 1.42 × 10⁹/L, C-reactive protein was 22.97 ± 6.13 mg/L, and procalcitonin was 10.77 ± 3.18 ng/mL; The control groups were 9.7 × 10⁹ ± 1.69 × 10⁹/L, 29.8 ± 7.4 mg/L, and 14.79 ± 4.44 ng/mL respectively. On the 5^th day after surgery: The white blood cell count of the observation group was 7.44 ± 1.31 × 10⁹/L, C-reactive protein was 18.59 ± 4.68 mg/L, and procalcitonin was 8.61 ± 2.18 ng/mL; The control groups were 8.63 × 10⁹ ± 1.41 × 10⁹/L, 24.41 ± 6.52 mg/L, and 12.65 ± 3.67 ng/mL, The postoperative index of the observation group was better than the control group. The difference between the two groups was statistically significant (P < 0.05; Table 3).

Table 3 Postoperative infection indicators.

Groups	n	White blood cell count (× 109/L)		C-reactive protein (mg/L)		Procalcitonin (ng/mL)
		3 days after surgery	5 days after surgery	3 days after surgery	5 days after surgery	3 days after surgery	5 days after surgery
Observation group	50	8.55 ± 1.42	7.44 ± 1.31	22.97 ± 6.13	18.59 ± 4.68	10.77 ± 3.18	14.79 ± 4.44
Control group	50	9.7 ± 1.69	8.63 ± 1.41	29.8 ± 7.4	24.41 ± 6.52	8.61 ± 2.18	12.65 ± 3.67
t value		-5.17	-6.27	-7.34	-6.18	-7.26	-9.45
P value		0.01	0.02	0.01	0.00	0.01	0.03

Mental health indicators

In terms of mental health, the anxiety and depression scores of patients in the observation group were significantly lower than those in the control group. The difference between the two groups was statistically significant (P < 0.05; Table 4).

Table 4 Mental health indicators.

Index	Observation group	Control group	t value	P value
Anxiety score	20.85 ± 4.26	24.73 ± 5.54	-5.54	< 0.05
Depression score	18.09 ± 3.98	22.78 ± 5.33	-7.06	< 0.05

Hospital stays and costs

The hospitalization time of the observation group was significantly shorter than that of the control group. The hospitalization cost of the observation group was significantly lower than that of the control group. The difference between the two groups was statistically significant (P < 0.05; Table 5).

Table 5 Hospital stay and costs.

Index	Observation group	Control group	t value	P value
Average length of stay (days)	8.69 ± 1.09	10.29 ± 1.64	-8.10	< 0.05
Average hospitalization cost (yuan)	11938.41 ± 1471.3	14194.67 ± 1815.05	-9.66	< 0.05

DISCUSSION

In the treatment of abdominal infections in children, the application of broad-spectrum bacterial infection nucleic acid detection can improve diagnostic accuracy and guide the rational use of antibiotics, thus reducing the risk of treatment failure and complications. On the other hand, as people pay more attention to patients' quality of life and mental health, the role of mental health in disease treatment has attracted increasing attention[22]. Pediatric patients with abdominal infection are often accompanied by psychological problems such as anxiety and depression, which not only affects the patient's recovery process, but may also increase the consumption of medical resources and treatment costs. Therefore, assessing patients' mental health status and taking corresponding psychological intervention measures is of great significance to improving treatment effects and reducing medical expenses[23]. This study aims to explore the therapeutic effects, costs, and mental health improvement of patients who undergo early broad-spectrum bacterial infection nucleic acid testing vs only intraoperative bacterial culture + drug sensitivity testing in the surgical treatment of pediatric abdominal infections.

First, this study observed that before surgery, there was no significant difference in infection indicators (including white blood cell count, C-reactive protein, and procalcitonin) between the observation group and the control group. This shows that the two groups of patients had similar levels of infection before surgery and similar basic clinical characteristics, making the comparison results more reliable. Secondly, the comparison of postoperative infection indicators showed that on the third and fifth days after surgery, the infection indicators of patients in the observation group were significantly lower than those of patients in the control group. This shows that conducting broad-spectrum bacterial infection nucleic acid detection in advance can help identify pathogens earlier and guide the rational application of antibiotics, thereby effectively controlling the development of infection. This is also consistent with the results of previous studies, confirming the importance of nucleic acid detection of broad-spectrum bacterial infections in the treatment of abdominal infections in children. In addition, the mental health status of the patients in the observation group after surgery was significantly better than that of the patients in the control group, as shown by lower anxiety and depression scores. This may be because early broad-spectrum bacterial infection nucleic acid testing reduces surgical risks and complications, improves patients' confidence in treatment, and thereby reduces their psychological burden. The impact of mental health on the recovery process cannot be ignored[22]. This result prompts the clinical need to pay more attention to patients' mental health and provide corresponding psychological support and intervention. Finally, the average hospitalization time and costs of patients in the observation group were significantly lower than those of patients in the control group. This shows that conducting broad-spectrum bacterial infection nucleic acid testing in advance can not only improve the treatment effect, but also save medical resources and reduce medical costs. This is of great significance for reducing medical burden and optimizing the allocation of medical resources.

There are some limitations of this study that need to be noted. First, the sample size is relatively small, which may affect the stability and generalizability of the research results. Future studies can increase the sample size to further validate the results. Secondly, this study adopted a retrospective design, and there are biases in information acquisition and the influence of confounding factors. Therefore, the influence of other potential factors on the results cannot be ruled out. Further prospective studies could better explore causal relationships. In addition, this study only focused on the role of early broad-spectrum bacterial infection nucleic acid detection in treatment, and did not fully consider other factors that may affect the treatment effect. Therefore, future research can combine more clinical variables and conduct multifactor analysis to obtain more comprehensive conclusions. Finally, the observation period of this study was short and only the index changes on the 3^rd and 5^th days after surgery were examined. The long-term treatment effect remains to be further observed. Therefore, long-term follow-up studies of patients' recovery are needed to better evaluate the durability and stability of treatment effects[15,24].

CONCLUSION

In summary, the results of this study show that early detection of broad-spectrum bacterial infection nucleic acids has good clinical application prospects in the surgical treatment of abdominal infections in children, and can improve treatment effects, reduce patients' psychological burden, and save medical resources. However, this study also has some limitations, such as a small sample size and a retrospective cohort study design. Therefore, more large-sample, multi-center prospective studies are needed to verify these results.