Young Michael H, Washer Laraine, Malani Preeti N
Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA.
Drugs Aging. 2008;25(5):399-414. doi: 10.2165/00002512-200825050-00004.
Surgical site infections (SSIs) represent a major source of morbidity and mortality among older adults. In this review we discuss the epidemiology and risk factors for SSIs among older adults. We also offer an overview of current treatment and management strategies for several common SSIs. Our comments focus on the following areas in order to illustrate issues of clinical importance in the older patient: (i) cardiac surgery; (ii) vascular grafts; (iii) total joint arthroplasty; (iv) breast surgery; and (v) spinal surgeries. Besides being common and relatively specific to older adults, several of these surgical procedures require the use of prosthetic materials or devices, which present unique treatment challenges in the context of infection. When an older adult does develop an SSI, it is critical for clinicians to establish an overall treatment goal for each patient. In the majority of patients, this will be either complete cure or remission followed by suppressive therapy. However, clinicians caring for older adults must consider not only the possibility of microbiological cure, but also balance the need to preserve functional status and overall quality of life. Infections associated with devices and prosthetic material can present unique treatment challenges. Treatment of significant infections often requires prolonged courses of parenteral and/or oral antimicrobial therapy, which can raise issues related to the safety and tolerability of antimicrobial agents, including higher rates of nephrotoxicity. Issues concerning overall functional status, nutritional reserve and medical co-morbidities must be taken into consideration when approaching SSIs in an older adult.
手术部位感染（SSIs）是老年人发病和死亡的主要原因之一。在本综述中，我们讨论了老年人手术部位感染的流行病学和危险因素。我们还概述了几种常见手术部位感染的当前治疗和管理策略。我们的评论集中在以下几个方面，以阐述老年患者临床重要问题：（i）心脏手术；（ii）血管移植；（iii）全关节置换术；（iv）乳腺手术；以及（v）脊柱手术。除了常见且相对特定于老年人外，这些手术中有几种需要使用假体材料或装置，这在感染情况下带来了独特的治疗挑战。当老年人确实发生手术部位感染时，临床医生为每位患者确立总体治疗目标至关重要。在大多数患者中，这将是完全治愈或缓解后进行抑制性治疗。然而，照顾老年人的临床医生不仅必须考虑微生物治愈的可能性，还必须权衡保持功能状态和总体生活质量的需求。与装置和假体材料相关的感染可能带来独特的治疗挑战。严重感染的治疗通常需要长时间的肠外和/或口服抗菌治疗疗程，这可能引发与抗菌药物安全性和耐受性相关的问题，包括更高的肾毒性发生率。在处理老年人手术部位感染时，必须考虑整体功能状态、营养储备和合并症等问题。
