Houang E T, Ahmet Z
Department of Microbiology, Queen Charlotte's and Chelsea Hospital, London.
J Hosp Infect. 1991 Nov;19(3):181-9. doi: 10.1016/0195-6701(91)90222-t.
Qualitative bacterial culture of specimens taken from several operative sites during abdominal hysterectomy has not been of value in predicting postoperative infection. We have therefore studied the relationship between the magnitude of contamination and the likelihood of the development of postoperative infection, in the course of a trial comparing the efficacy of cefotetan with ampicillin-plus-metronidazole for chemoprophylaxis in 163 women undergoing abdominal hysterectomy. Forty women who did not receive chemoprophylaxis were also studied. From each patient, an intraoperative sample of pelvic fluid was obtained after closure of the vaginal vault and examined quantitatively for anaerobic, aerobic and microaerophilic bacteria. The incidence of postoperative infectious morbidity (wound infection and febrile morbidity) was correlated with bacterial counts. Analyses by step-up multiple logistic regressions were performed on all the variables and only the total and microaerophilic bacterial counts were significant. Of the 40 patients with total bacterial counts greater than or equal to 10(4) cfu ml-1, 42.5% developed postoperative infectious morbidity, compared with 12.6% of 135 of patients with counts of less than or equal to 10(3) cfu ml-1. The contaminating bacteria were similar to those of the vaginal and skin flora, with anaerobes occurring in 52.9% and microaerophiles in 63.9% of positive fluid samples. Thus, we have concluded that the magnitude of contamination during abdominal hysterectomy is an important determinant in the development of postoperative infectious morbidity.
在腹部子宫切除术中，对取自多个手术部位的标本进行定性细菌培养，对于预测术后感染并无价值。因此，在一项比较头孢替坦与氨苄西林加甲硝唑对163例行腹部子宫切除术女性进行化学预防效果的试验过程中，我们研究了污染程度与术后感染发生可能性之间的关系。还对40例未接受化学预防的女性进行了研究。在关闭阴道穹窿后，从每位患者获取术中盆腔液体样本，对厌氧、需氧和微需氧细菌进行定量检测。术后感染性发病（伤口感染和发热性发病）的发生率与细菌计数相关。对所有变量进行逐步多元逻辑回归分析，只有总细菌计数和微需氧细菌计数具有显著性。在40例总细菌计数大于或等于10⁴ cfu/ml的患者中，42.5%发生了术后感染性发病，而在135例计数小于或等于10³ cfu/ml的患者中，这一比例为12.6%。污染细菌与阴道和皮肤菌群相似，在阳性液体样本中，厌氧菌占52.9%，微需氧菌占63.9%。因此，我们得出结论，腹部子宫切除术中的污染程度是术后感染性发病发生的一个重要决定因素。
