Howard Drew D, White Cassandra Q, Harden Tara R, Ellis C Neal
Department of Surgery, University of South Alabama, Mobile, Alabama, USA.
Am Surg. 2009 Aug;75(8):659-63; discussion 663-4.
This study was performed to determine the incidence of surgical site infections (SSIs) after colorectal resection in patients without mechanical or antibiotic bowel preparation. A retrospective review of the medical records of 136 consecutive patients undergoing an elective colorectal resection between April 2004 and April 2006 was performed. Indications for colon resection in this series were malignant neoplasia (48%), inflammatory bowel disease (18%), diverticular disease (17%), or other benign disease (17%). Overall, an SSI occurred in 31 patients (23%). An SSI occurred in 16 of 90 patients (17.8%) who received antibiotics within 1 hour before surgery and in 15 of 46 patients (33.3%) who did not receive antibiotics in a timely manner (P < 0.05). An SSI occurred in seven of 15 patients (46.7%) who received bowel preparation but in only 24 of 121 patients (19.8%) who did not receive either mechanical or antibiotic bowel preparation (P < 0.029). SSIs were not associated with age, gender, diagnosis, length of procedure, preoperative steroid use, diabetes mellitus, or previous celiotomy. This series shows administration of perioperative antibiotics within 1 hour before surgery is associated with a significant decrease in the incidence of SSI and bowel preparation can be safely omitted.
本研究旨在确定未进行机械性或抗生素肠道准备的患者行结直肠切除术后手术部位感染(SSI)的发生率。对2004年4月至2006年4月期间连续136例行择期结直肠切除术患者的病历进行回顾性分析。本系列结肠切除的指征为恶性肿瘤(48%)、炎症性肠病(18%)、憩室病(17%)或其他良性疾病(17%)。总体而言,31例患者(23%)发生了SSI。术前1小时内接受抗生素治疗的90例患者中有16例(17.8%)发生了SSI,未及时接受抗生素治疗的46例患者中有15例(33.3%)发生了SSI(P<0.05)。接受肠道准备的15例患者中有7例(46.7%)发生了SSI,但未接受机械性或抗生素肠道准备的121例患者中只有24例(19.8%)发生了SSI(P<0.029)。SSI与年龄、性别、诊断、手术时间、术前使用类固醇、糖尿病或既往剖腹手术无关。本系列研究表明,术前1小时内给予围手术期抗生素与SSI发生率显著降低相关,并且可以安全地省略肠道准备。