Stojadinovic Miroslav M, Mićić Sava R, Milovanović Dragan R
Department of Urology, Clinic of Urology and Nephrology, Clinical Centre Kragujevac, Zmaj Jovina 30, 34 000 Kragujevac, Serbia.
Int J Urol. 2008 Aug;15(8):699-703. doi: 10.1111/j.1442-2042.2008.02083.x. Epub 2008 Jun 2.
Risk factors for surgical site infection (SSI) following urologic dirty operations have not been clearly identified. This study was conducted to describe incidence, potential risk factors and common causative pathogens of the SSI in such operations.
Medical records of patients who had undergone simple nephrectomy or lumbotomy for suppurative renal infection at our institutions from 1999 to 2006 were retrospectively evaluated. The following data were retrieved: presence of SSI, demographic data, laboratory findings, comorbidities, microbiological data, type of renal suppuration, type of urological surgery and antibiotic regimen. Risk factors for SSI were evaluated using the multiple logistic regression model.
Sixty-five patients (mean age 55.6 +/- 13.1 years) were eligible for data analysis. In 20 of them (30.8%) a SSI was identified. The most common isolated pathogens were gram-negative bacteria. At univariate logistic regression analysis risk factors significantly associated with SSI included: presence of emphysematous infection, hypoalbuminemia, number of predisposing conditions, emergency operations, isolation of Enterobacteriaceae, positive pus culture. The use of trimethoprim/sulfamethoxazole was associated with a decreased risk for SSI. Multiple logistic model identified only the emergency operations and isolated Enterobacteriaceae as independent predictors of SSI (odds ratio [OR] = 11.1) (95% confidence interval [CI] = 3.0-40.8) and OR = 3.9 (1.0-14.8), respectively.
Patients with suppurative renal infections are submitted to life-saving emergency surgery. Urological surgeons should keep in mind that this carries a high risk for subsequent SSI. Effective preventive measures in these circumstance cannot be identified. Further research in this area is necessary to clarify this issue.
泌尿外科污染手术术后手术部位感染（SSI）的危险因素尚未明确界定。本研究旨在描述此类手术中SSI的发生率、潜在危险因素及常见致病病原体。
回顾性评估1999年至2006年期间在我院因化脓性肾感染接受单纯肾切除术或腰部切开术患者的病历。收集以下数据：SSI的存在情况、人口统计学数据、实验室检查结果、合并症、微生物学数据、肾化脓类型、泌尿外科手术类型及抗生素使用方案。使用多因素逻辑回归模型评估SSI的危险因素。
65例患者（平均年龄55.6±13.1岁）符合数据分析要求。其中20例（30.8%）发生了SSI。最常见的分离病原体为革兰氏阴性菌。单因素逻辑回归分析显示，与SSI显著相关的危险因素包括：气肿性感染的存在、低白蛋白血症、易感因素数量、急诊手术、肠杆菌科细菌的分离、脓液培养阳性。使用甲氧苄啶/磺胺甲恶唑与SSI风险降低相关。多因素逻辑模型仅确定急诊手术和分离出肠杆菌科细菌为SSI的独立预测因素（优势比[OR]=11.1）（95%置信区间[CI]=3.0 - 40.8）和OR = 3.9（1.0 - 14.8），分别。
化脓性肾感染患者需接受挽救生命的急诊手术。泌尿外科医生应牢记，这会使后续发生SSI的风险很高。在这些情况下无法确定有效的预防措施。有必要在该领域进行进一步研究以阐明这一问题。
