Investigation of postoperative allograft-associated infections in patients who underwent musculoskeletal allograft implantation
Investigation of postoperative allograft-associated infections in patients who underwent musculoskeletal allograft implantation
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DOI：
10.1086/430911
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发表时间：
2005-07-15
影响因子：
11.8
通讯作者：
Archibald, LK
中科院分区：
文献类型：
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作者：
Crawford, C;Kainer, M;Archibald, LK
背景在过去的十年中，同种异体移植在美国外科手术中的使用率翻了一番。2002年，一个门诊手术中心（SC-X）发现了前交叉韧带重建手术（ACLRS）后的一组手术部位感染（SSI）。因此，我们进行了一项调查，以确定爆发的程度，并确定风险因素。我们的研究包括回顾性队列研究和观察性研究。病例患者定义为2000年2月至2002年6月（研究期间）在SC-X接受ACLRS后发生SSI的任何患者。收集的数据包括人口统计学特征、临床信息和移植物细节，如处理方法（即，无菌的或无菌的）。在研究期间接受ACLRS的331例患者中，11例（3.3%）符合病例定义。所有感染均发生在移植物的胫骨固定部位，涉及8种不同的微生物;至阳性培养结果的中位时间为ACLRS后55天。接受无菌处理的同种异体移植物的患者感染率为4.4%（11/250），而接受自体移植物或无菌同种异体移植物的患者感染率为0%（0/81）（P = 0.07）。在单变量分析中，与不使用此类斯台普斯的其他固定方法相比，使用补充钉进行胫骨固定会使感染风险增加10倍（相对风险[RR]，10.0; 95%置信区间[CI]，3.0 - 32.9）和9倍（当控制组织处理方法时）（RR，9.0; 95%CI，2.8 - 28.8）。使用无菌同种异体移植组织似乎与术后感染风险的显著降低相关，特别是在存在连续固定的情况下。需要更大规模的临床研究来证实这一观察结果。
Background. The rate at which allografts are used in surgical procedures has doubled in the United States during the past decade. In 2002, one outpatient surgical center (SC-X) identified a cluster of surgical site infections (SSIs) after anterior cruciate ligament reconstructive surgery (ACLRS). Therefore, we conducted an investigation to determine the extent of the outbreak and to identify risk factors.Methods. Our investigation included retrospective cohort and observational studies. A case patient was defined as any patient who acquired a SSI after undergoing ACLRS at SC-X between February 2000 and June 2002 ( the study period). Data collected included demographic characteristics, clinical information, and graft details, such as processing method (i.e., aseptic or sterile).Results. Of 331 patients who underwent ACLRS during the study period, 11 (3.3%) met the case definition. All infections occurred at the tibial fixation site of the graft and involved 8 different microorganisms; the median time to a positive culture result was 55 days after ACLRS. The infection rate for patients who received aseptically processed allografts was 4.4% ( 11 of 250 patients), compared with 0% ( 0 of 81) for patients who received autografts or sterile allografts (P = .07). Use of a supplementary staple for tibial fixation, compared with other fixation methods that did not involve such staples, increased the risk of infection 10-fold in univariate analysis (relative risk [RR], 10.0; 95% confidence interval [CI], 3.0 - 32.9) and 9-fold when controlling for tissue processing method (RR, 9.0; 95% CI, 2.8 - 28.8).Conclusions. The use of sterile allograft tissue appears to be associated with a significant reduction in the risk of postoperative infection, particularly in the presence of adjunctive fixation. Larger clinical studies are necessary to confirm this observation.