A prospective randomised trial of isolated pathogens of surgical site infections (SSI).
A prospective randomised trial of isolated pathogens of surgical site infections (SSI).
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DOI：
10.1016/j.amsu.2017.07.045
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发表时间：
2017-09
期刊：
影响因子：
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通讯作者：
Economou N
中科院分区：
文献类型：
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作者：
Alexiou K;Drikos I;Terzopoulou M;Sikalias N;Ioannidis A;Economou N
每个手术伤口都被细菌定植，但只有一小部分出现感染症状。在过去的几十年里，手术部位感染中分离出的病原体的分布没有显着变化。葡萄球菌。金黄色葡萄球菌、Coag(-) 葡萄球菌、肠球菌和大肠杆菌是出现的主要菌株。此外，据报道，由耐药细菌（MRSA、白色念珠菌）引起的手术部位感染比例持续上升。这项前瞻性随机临床研究于 2009 年 2 月至 2015 年 2 月在雅典西斯马诺里昂总医院第一外科诊所进行。接受上消化系统或下消化系统择期手术的患者被随机接受抗菌治疗作为化学预防。每个患者都填写了一份专门的监测表，记录流行病学数据、手术相关信息、手术部位感染（深部和浅表）以及术后发病情况（包括泌尿道和呼吸道感染）。患者住院期间每天进行多次访视，并在出院后通过电话继续监测至术后第 30 天。我们的总体 SSI 发生率为 4.3%（总共 715 名患者中的 31 名患者）。具体而言，上胃肠道预定手术的 SSI 发生率为 2.2%（500 名患者中的 11 名），下胃肠道的 SSI 发生率为 9.3%（215 名患者中的 20 名）。从 SSI 患者中分离出 7 种主要病原体：大肠杆菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、脆弱拟杆菌、金黄色葡萄球菌和粪肠球菌。它们的增长率分别为：金黄色葡萄球菌（17.3%）、粪肠球菌（19.5%）、铜绿假单胞菌（10.5%）、脆弱芽孢杆菌（13.4%）、大肠杆菌（20.4%）、阴沟肠杆菌（9.1%）和肺炎克雷伯菌（9.8%）。此外，所有 SSI 均被发现具有多种微生物。多项研究已经表明，患者特征和共存疾病，如肥胖、吸烟、心力衰竭或肾衰竭、既往局部感染和患者年龄（特别是年龄超过 65 岁）似乎是手术区域感染的独立预后因素。此外，手术伤口的分类、手术操作的复杂程度、术前住院情况、手术时间的延长和输血的需要已被证明可以区分 SSI 的发生率。总之，手术部位感染是影响医疗服务、住院费用和患者本人的重要并发症。未来的彻底研究预计将揭示更多关于易感性和预防性患者和医院特征的数据。从 SSI 患者中分离出 7 种主要病原体：大肠杆菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、脆弱拟杆菌、金黄色葡萄球菌和粪肠球菌。 SSI 发生率为 4.3%（715 名患者中有 31 名患者）。所有预定的胃肠道手术和 SSI 都属于潜在污染，发生率为 7-8%。参与我们研究的所有患者都接受了上消化系统或下消化系统的预定手术，如上所述，这些手术被认为可能受到污染。
Every surgical wound is colonized by bacteria, but only a small percentage displays symptoms of infection. The distribution of pathogens isolated in surgical site infections has not significantly changed over the last decades. Staph. Aureus, Coag(-) Staphylococci, Enterococcus spp and E. Coli are the main strains appearing. In addition, a continuously rising proportion of surgical site infections caused by resistant bacterial species (MRSA, C. Albicans) has been reported. This prospective and randomized clinical study was performed in the 1st Surgical Clinic of Sismanoglion General Hospital of Athens, from February 2009 to February 2015. Patients undergoing elective surgery in the upper or lower digestive system were randomized to receive antimicrobial treatment as chemoprophylaxis. Each patient filled a special monitoring form, recording epidemiological data, surgery related information, surgical site infections (deep and superficial), as well as postoperative morbidity (urinary and respiratory infections included). The monitoring of patients was carried by multiple visits on a daily basis during their hospitalization and continued after they were discharged via phone to postoperative day 30. Our overall SSI incidence was 4,3% (31patients out of a whole of 715 patients). Specifically, the incidence of SSIs for scheduled surgery of the upper GI tract was 2,2% (11 out of 500 patients) and for the lower GI tract was 9,3% (20 out of 215 patients). Seven main pathogens were isolated from patients with SSIs: Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Bacteroides fragilis, Staphylococcus aureus and Enterococcus faecalis. Their growth rates were respectively: S. Aureus (17,3%), E. faecalis (19,5%), P. aeruginosa (10,5%), B. Fragilis (13,4%) E. coli (20,4%), Enterobacter cloacae (9,1%) and K. Pneumoniae (9,8%). In addition, all the SSIs were found to be multimicrobial. Several studies have already revealed that patient characteristics and coexisting morbidities such as obesity, smoking, heart or renal failure, pre-existing localized infections and patients' age (especially if age exceeds 65) seem to be independent prognostic factors for surgical field infections. Additionally, classification of the surgical wound, surgical operation complexity, preoperative hospitalization, prolongation of surgical time and need for transfusions have been proved to differentiate the incidence of SSIs. In conclusion, surgical site infections are important complications affecting the healthcare services, the cost of hospitalization and the patient himself. Future thorough studies are expected to reveal much more data, regarding predisposing and precautionary patient and hospital characteristics. Seven main pathogens were isolated from patients with SSIs: Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Bacteroides fragilis, Staphylococcus aureus and Enterococcus faecalis. SSI incidence was 4,3% (31 patients out of a whole of 715 patients). Potentially contaminated are all scheduled operations of the GI tract and SSIs appear in this classification with an incidence of 7–8%. All patients participating in our study underwent scheduled operations of the upper or lower digestive system, considered potentially contaminated as stated.