McIntosh J, Earnshaw J J
Department of Vascular Surgery, Gloucestershire Royal Hospital, Gloucester, United Kingdom.
Eur J Vasc Endovasc Surg. 2009 Jun;37(6):696-703. doi: 10.1016/j.ejvs.2009.01.013. Epub 2009 Mar 26.
Major limb amputation is often required by patients with a limited capacity to tolerate post-operative complications. Amputation stump infection is common and may necessitate re-amputation, potentially exposing a vulnerable patient to further serious complications. Effective antibiotic strategies should be employed to reduce wound infection after major amputation.
Online databases were searched to identify studies regarding reduction in wound infection following major limb amputation. Only four randomised studies were identified comparing antibiotic prophylaxis with control; a further three evaluated the efficacy of specific antibiotics. Study design, end-points and outcome data were recorded. The data were too heterogeneous for formal meta-analysis.
Prophylactic antibiotics significantly reduced rates of stump infection in all studies, and were associated with a reduced rate of re-amputation in one. Where investigated, the type of antibiotic did not affect rates of infection. In non-randomised studies, infection with methicillin resistant Staphylococcus aureus (MRSA) increased the risk of complications and post-operative death.
It is agreed that prophylactic antibiotics are part of the standard of care for amputation surgery, and this is supported by limited, mostly historical-controlled data. Evolution of the bacterial threat means that future studies should assess the role and type of prophylaxis for patients with existing bacterial colonisation or infection.
对于耐受术后并发症能力有限的患者，通常需要进行大肢体截肢。截肢残端感染很常见，可能需要再次截肢，这可能会使脆弱的患者面临进一步的严重并发症。应采用有效的抗生素策略来减少大截肢术后的伤口感染。
检索在线数据库以识别有关减少大肢体截肢术后伤口感染的研究。仅确定了四项比较抗生素预防与对照的随机研究；另外三项评估了特定抗生素的疗效。记录研究设计、终点和结果数据。数据过于异质，无法进行正式的荟萃分析。
在所有研究中，预防性抗生素均显著降低了残端感染率，并且在一项研究中与再次截肢率降低相关。在进行调查的情况下，抗生素类型不影响感染率。在非随机研究中，耐甲氧西林金黄色葡萄球菌（MRSA）感染增加了并发症和术后死亡的风险。
人们一致认为预防性抗生素是截肢手术标准治疗的一部分，有限的、大多为历史对照的数据支持了这一点。细菌威胁的演变意味着未来的研究应评估对现有细菌定植或感染患者进行预防的作用和类型。
