Re-examining causes of surgical site infections following elective surgery in the era of asepsis.
Re-examining causes of surgical site infections following elective surgery in the era of asepsis.
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DOI：
10.1016/s1473-3099(19)30756-x
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发表时间：
2020-03
期刊：
影响因子：
--
通讯作者：
Gilbert J
中科院分区：
文献类型：
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作者：
Alverdy JC;Hyman N;Gilbert J
目前公认的假设是，在标准消毒方法下进行择期手术后发生的大多数手术部位感染（SSI）是由于术中污染事件造成的，这一假设尚未得到证实。我们检查了手术结束时对手术伤口进行微生物培养的现有证据，并确定这些研究提供了更多的证据来反驳SSI是由于术中污染而不是支持它。我们建议应考虑SSI发展的替代机制，例如当无菌术后伤口被源自远离手术伤口的部位-例如牙龈或肠道-的病原体感染时（即特洛伊木马机制）。我们提供了一条减少择期手术后SSI发生率的途径，包括从建筑环境（即手术室和病床）到患者自身的微生物组，然后到手术部位进行基于基因组的微生物跟踪。最后，我们认为，只有通过生成这种动态微生物图谱，才能充分了解SSI的真正发病机制，从而为当前无菌时代的择期手术后感染的新预防策略提供信息。
The currently accepted assumption that most surgical site infections (SSIs) occurring after elective surgery under standard methods of antisepsis are due to an intraoperative contamination event, remains unproven. We examined the available evidence in which microbial cultures of surgical wounds were taken at the conclusion of an operation and determined that such studies provide more evidence to refute that an SSI is due to intraoperative contamination than support it. We propose that alternative mechanisms of SSI development should be considered, such as when a sterile postoperative wound becomes infected by a pathogen originating from a site remote from the operative wound—eg, from the gums or intestinal tract (ie, the Trojan Horse mechanism). We offer a path forward to reduce SSI rates after elective surgery that includes undertaking genomic-based microbial tracking from the built environment (ie, the operating room and hospital bed), to the patient’s own microbiome, and then to the surgical site. Finally, we posit that only by generating this dynamic microbial map can the true pathogenesis of SSIs be understood enough to inform novel preventive strategies against infection following elective surgery in the current era of asepsis.