Asensio Angel, Ramos Antonio, Cuervas-Mons Valentin, Cordero Elisa, Sánchez-Turrión Victor, Blanes Marino, Cervera Carlos, Gavalda Joan, Aguado Jose M, Torre-Cisneros Julian
Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain.
Liver Transpl. 2008 Jun;14(6):799-805. doi: 10.1002/lt.21435.
Surgical site infections are common bacterial infections in orthotopic liver transplantation. The purpose of this study was to determine the incidence, timing, location, and risk factors, specifically antibiotic prophylaxis, for surgical site infections. A prospective study was performed that included a population of 1222 consecutive patients (73.0% males) who underwent liver transplantation in Spanish hospitals belonging to the Red de Estudio de la Infección en el Trasplante research network. One hundred seven patients developed surgical site infections. The predominant infection sites were incisional wound (53 episodes) and peritonitis (40 episodes). The timing of the organ/space surgical site infections was slightly delayed in comparison with incisional surgical site infections. Enterococcus spp., Escherichia coli, Staphylococcus aureus, and Acinetobacter baumannii were the predominant pathogens. Choledochojejunal or hepaticojejunal reconstruction (odds ratio, 4.2; 95% confidence interval, 1.6-10.7), previous liver or kidney transplant (odds ratio, 2.6; 95% confidence interval, 1.1-6.3), and more than 4 red blood cell units transfused (odds ratio, 2.0; 95% confidence interval, 1.1-3.4) were independently associated with the development of surgical site infections. Biliary reconstruction by choledochojejunostomy or hepaticojejunostomy increases the risk of surgical site infections.
手术部位感染是原位肝移植中常见的细菌感染。本研究的目的是确定手术部位感染的发生率、发生时间、感染部位及危险因素，特别是抗生素预防措施。进行了一项前瞻性研究，纳入了西班牙属于肝移植感染研究网络的医院中连续接受肝移植的1222例患者（男性占73.0%）。107例患者发生了手术部位感染。主要感染部位为手术切口（53例）和腹膜炎（40例）。与手术切口感染相比，器官/腔隙手术部位感染的发生时间略有延迟。肠球菌属、大肠埃希菌、金黄色葡萄球菌和鲍曼不动杆菌是主要病原体。胆肠吻合或肝肠吻合重建（优势比，4.2；95%置信区间，1.6 - 10.7）、既往肝或肾移植（优势比，2.6；95%置信区间，1.1 - 6.3）以及输注超过4个单位红细胞（优势比，2.0；95%置信区间，1.1 - 3.4）与手术部位感染的发生独立相关。通过胆肠吻合术或肝肠吻合术进行胆道重建会增加手术部位感染的风险。
