Yamamoto Shingo, Kunishima Yasuharu, Kanamaru Sojun, Ito Noriyuki, Kinoshita Hidefumi, Kamoto Toshiyuki, Ogawa Osamu, Arai Yoichi, Okumura Kazuhiro, Terachi Toshiro, Moroi Seiji, Okada Yusaku, Nishio Yasunori, Kanamaru Hirofumi, Inui Masashi, Asazuma Akira, Kanatani Isao, Sasaki Miharu, Nishikawa Nobuyuki, Hida Shuichi, Nonomura Mitsuo, Terai Akito, Ogura Keiji, Mitsumori Kenji, Nishimura Kazuo, Onishi Hiroyuki, Horii Yasuki, Yamasaki Toshinari
Department of Urology, Graduate School of Medicine, Kyoto University.
Hinyokika Kiyo. 2004 Oct;50(10):673-83.
In order to assess the ability of our protocol for antibiotic prophylaxis to prevent perioperative infections in urologic surgery, 1,353 operations of open and laparoscopic urologic surgery conducted in 21 hospitals between September 2002 and August 2003 were subjected to analyses. We classified surgical procedures into four categories by invasiveness and contamination levels: Category A; clean less invasive surgery, Category B; clean invasive or clean-contaminated surgery, Category C; surgery with urinary tract diversion using the intestine. Prophylactic antibiotics were administrated intravenously according to our protocol, such as Category A; first or second generation cephems or penicillins on the operative day only, Category B; first and second generation cephems or penicillins for 3 days, and Category C; first, second or third generation cephems or penicillins for 4 days. The wound conditions and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 30. The SSI rate highest (23.3%) for surgery with intestinal urinary diversion, followed by 10.0% for surgery for lower urinary tract, 8.9% for nephroureterctomy, and 6.0% for radical prostatectomy. The SSI rates in clean surgery including open and laparoscopic nephrectomy/adrenalectomy were 0.7 and 1.4%, respectively. In SSIs, gram-positive cocci such as methicillin-resistant Staphylococcus aureus (58.8%) or Enterobacter faecalis (26.5%) were the most common pathogen. Similarly, the RI rate was the highest (35.2%) for surgery using intestinal urinary diversion, followed by 16.7% for surgery for lower urinary tract, 11.4% for nephroureterctomy, and 7.6% for radical prostatectomy, while RI rates for clean surgery were less than 5%. RIs most frequently reported were urinary tract infections (2.6%) where Pseudomonas aeruginosa (20.3%) and Enterobacter faecalis (15.3%) were the major causative microorganisms. Parameters such as age, obesity, nutritional status (low proteinemia), diabetes mellitus, lung disease, duration of operation, and blood loss volume were recognized as risk factors for SSI or RI in several operative procedures. Postoperative body temperatures, peripheral white blood counts, C reactive protein (CRP) levels in POD 3 were much higher than those in POD 2 in cases suffering from perioperative infections, especially suggesting that CRP could be a predictable marker for perioperative infections.
为评估我们的抗生素预防方案预防泌尿外科手术围手术期感染的能力，对2002年9月至2003年8月期间在21家医院进行的1353例开放和腹腔镜泌尿外科手术进行了分析。我们根据侵入性和污染程度将手术程序分为四类：A类；清洁的低侵入性手术，B类；清洁的侵入性或清洁-污染手术，C类；使用肠道进行尿路改道的手术。预防性抗生素按照我们的方案静脉给药，例如A类；仅在手术当天使用第一代或第二代头孢菌素或青霉素，B类；第一代和第二代头孢菌素或青霉素使用3天，C类；第一代、第二代或第三代头孢菌素或青霉素使用4天。在术后30天内，从手术部位感染（SSI）以及远处感染（RI）方面评估伤口情况和一般情况。肠道尿路改道手术的SSI发生率最高（23.3%），其次是下尿路手术的10.0%、肾输尿管切除术的8.9%和根治性前列腺切除术的6.0%。包括开放和腹腔镜肾切除术/肾上腺切除术在内的清洁手术的SSI发生率分别为0.7%和1.4%。在SSI中，革兰氏阳性球菌如耐甲氧西林金黄色葡萄球菌（58.8%）或粪肠球菌（26.5%）是最常见的病原体。同样，使用肠道尿路改道手术的RI发生率最高（35.2%），其次是下尿路手术的16.7%、肾输尿管切除术的11.4%和根治性前列腺切除术的7.6%，而清洁手术的RI发生率低于5%。最常报告的RI是尿路感染（2.6%），其中铜绿假单胞菌（20.3%）和粪肠球菌（15.3%）是主要致病微生物。年龄、肥胖、营养状况（低蛋白血症）、糖尿病、肺部疾病、手术持续时间和失血量等参数在一些手术中被认为是SSI或RI的危险因素。围手术期感染患者术后第3天的体温、外周白细胞计数、C反应蛋白（CRP）水平远高于术后第2天，尤其表明CRP可能是围手术期感染的一个可预测指标。
