Alexandria University Hospital, Alexandria, Egypt.
Am J Infect Control. 2012 Jun;40(5):426-30. doi: 10.1016/j.ajic.2011.07.001. Epub 2011 Sep 22.
Surgical site infections (SSIs) contribute significantly to patient morbidity and mortality and exhaust health care system resources. The main objectives of the study were to describe the incidence rates of SSIs among patients undergoing urologic or cardiothoracic surgeries, the associated risk factors, and the common causative etiologies found at Alexandria University Hospital in Egypt.
A prospective active surveillance study for patients undergoing urologic and cardiothoracic surgeries was implemented from July 2009 to December 2010. Patients were inspected daily for developing SSIs and with a 30-day postoperative follow-up. Wound swabs were obtained from patients who had clinical signs suggestive of infection. Swabs were cultured for bacterial identification and tested for antimicrobial sensitivity. Standard Centers for Disease Control and Prevention National Health Safety Network case definitions were used.
SSIs occurred in 187 (17%) of patients with complete follow-up (n = 1,062), of which 106 (57%) occurred in-hospital and 81 (43%) occurred after discharge. Higher SSI rates were observed in cardiothoracic surgeries (23.3%), compared with urologic surgeries (9%) (P < .001). A stepwise logistic model identified an increased risk of SSI for those who underwent cardiothoracic surgeries (odds ratio [OR], 4.7; 95% confidence interval [CI], 2.2-11.1), those aged >45 years (OR, 2.32; 95% CI, 1.35-4.01), increased duration of hospital stay before (OR, 1.03; 95% CI, 1.01-1.05) and after (OR, 1.07; 95% CI, 1.04-1.09) surgery, antibiotics ≤24 hours before surgery (OR, 2.54; 95% CI, 1.63-3.94), and dirty wounds (OR, 4.09; 95% CI, 1.60-10.43).
Measures to reduce the high rates of SSI need to be instituted through a multidisciplinary effort including infection control education and specific SSI prevention activities at Alexandria University Hospital.
手术部位感染（SSI）会显著增加患者的发病率和死亡率，并消耗医疗保健系统资源。本研究的主要目的是描述在埃及亚历山大大学医院接受泌尿外科或心胸外科手术的患者中 SSI 的发生率、相关危险因素和常见的病因。
从 2009 年 7 月至 2010 年 12 月，对接受泌尿外科和心胸外科手术的患者进行了前瞻性主动监测研究。每天对患者进行检查，以发现 SSI 并进行 30 天的术后随访。对有感染临床迹象的患者进行伤口拭子取样。对拭子进行细菌鉴定和抗菌药物敏感性检测。采用美国疾病控制与预防中心全国卫生安全网络标准病例定义。
在完成随访的 1062 例患者中（n=1062），187 例（17%）发生了 SSI，其中 106 例（57%）发生在院内，81 例（43%）发生在出院后。心胸外科手术的 SSI 发生率较高（23.3%），明显高于泌尿外科手术（9%）（P<0.001）。逐步逻辑模型确定了 SSI 的风险增加，其与心胸外科手术（比值比[OR]，4.7；95%置信区间[CI]，2.2-11.1）、年龄>45 岁（OR，2.32；95%CI，1.35-4.01）、术前住院时间延长（OR，1.03；95%CI，1.01-1.05）和术后（OR，1.07；95%CI，1.04-1.09）、术前 24 小时内使用抗生素（OR，2.54；95%CI，1.63-3.94）和污染伤口（OR，4.09；95%CI，1.60-10.43）有关。
需要通过多学科努力来降低 SSI 的高发生率，包括在亚历山大大学医院开展感染控制教育和特定的 SSI 预防活动。
