Merrer Jacques, Girou Emmanuelle, Lortat-Jacob Alain, Montravers Philippe, Lucet Jean-Christophe
Unite de Lutte contre les Infections Nosocomiales, Centre Hospitalier de Poissy-St Germain-en-Laye, Poissy, France.
Infect Control Hosp Epidemiol. 2007 Oct;28(10):1169-74. doi: 10.1086/520745. Epub 2007 Aug 29.
Femoral neck fracture is the most frequent orthopedic emergency among elderly persons. Despite a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage in this population, no multicenter study of antibiotic prophylaxis practices and the rate and microbiological characteristics of surgical site infection (SSI) has been performed in France.
Retrospective, multicenter cohort study.
Twenty-two university and community hospitals in France.
Each center provided data on 25 consecutive patients who underwent surgery for femoral neck fracture during the first quarter of 2005. Demographic, clinical, and follow-up characteristics were recorded, and most patients had a follow-up office visit or were involved in a telephone survey 1 year after surgery.
These 22 centers provided data on 541 patients, 396 (73%) of whom were followed up 1 year after surgery. Of 504 (93%) patients for whom antibiotic prophylaxis was recorded, 433 (86%) received a cephalosporin. Twenty-two patients had an SSI, for a rate of 5.6% (95% confidence interval, 3.7-8.0). SSI was reported for 15 (6.9%) of patients who had a prosthesis placed and for 7 (3.9%) who underwent osteosynthesis (P=.27). SSI was diagnosed a median of 30 days after surgery (interquartile range, 21-41 days); 7 (32%) of these SSIs were superficial infections, and 15 (68%) were deep or organ-space infections. MRSA caused 7 SSIs (32%), Pseudomonas aeruginosa caused 5 (23%), other staphylococci caused 4 (18%), and other bacteria caused 2 (9%); the etiologic pathogen was unknown in 4 cases (18%). Reoperation was performed for 14 patients with deep or organ-space SSI, including 6 of 7 patients with MRSA SSI. The mortality rate 1 year after surgery was 20% overall but 50% among patients with SSI. In univariate analysis, only the National Nosocomial Infections Surveillance System risk index score was significantly associated with SSI (P=.006).
SSI after surgery for femoral neck fracture is severe, and MRSA is the most frequently encountered etiologic pathogen. A large, multicenter prospective trial is necessary to determine whether the use of antibiotic prophylaxis effective against MRSA would decrease the SSI rate in this population.
股骨颈骨折是老年人中最常见的骨科急症。尽管该人群中甲氧西林耐药金黄色葡萄球菌（MRSA）携带率很高，但法国尚未开展关于抗生素预防措施以及手术部位感染（SSI）发生率和微生物学特征的多中心研究。
回顾性多中心队列研究。
法国的22家大学和社区医院。
每个中心提供了2005年第一季度连续25例接受股骨颈骨折手术患者的数据。记录了人口统计学、临床和随访特征，大多数患者在术后1年进行了门诊随访或参与了电话调查。
这22个中心提供了541例患者的数据，其中396例（73%）在术后1年进行了随访。在记录了抗生素预防措施的504例（93%）患者中，433例（86%）接受了头孢菌素治疗。22例患者发生了SSI，发生率为5.6%（95%置信区间，3.7 - 8.0）。植入假体的患者中有15例（6.9%）发生了SSI，接受骨固定术的患者中有7例（3.9%）发生了SSI（P = 0.27）。SSI在术后中位30天被诊断（四分位间距，21 - 41天）；其中7例（32%）SSI为表浅感染，15例（68%）为深部或器官间隙感染。MRSA导致7例SSI（32%），铜绿假单胞菌导致5例（23%），其他葡萄球菌导致4例（18%），其他细菌导致2例（9%）；4例（18%）病例的病原体病因不明。14例深部或器官间隙SSI患者进行了再次手术，包括7例MRSA SSI患者中的6例。术后1年的总死亡率为20%，但SSI患者中的死亡率为50%。在单因素分析中，只有国家医院感染监测系统风险指数评分与SSI显著相关（P = 0.006）。
股骨颈骨折手术后的SSI很严重，MRSA是最常见的病原体。有必要开展一项大型多中心前瞻性试验，以确定使用对MRSA有效的抗生素预防措施是否会降低该人群的SSI发生率。
