Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
Int J Colorectal Dis. 2013 Sep;28(9):1295-306. doi: 10.1007/s00384-013-1700-2. Epub 2013 Apr 21.
The high incidence of infectious complications in ulcerative colitis (UC) is generally recognized to be due to several factors related to a compromised host. In our previous study, a high dose of corticosteroid was shown to be a risk factor for surgical site infection (SSI). Recently, infliximab (IFX) has been used for refractory UC. In this study, the effect of IFX on the occurrence of infectious postoperative complications for UC was evaluated, because it remains controversial.
A total of 196 UC patients who underwent laparotomy between January 2010 and September 2012 were included. Possible factors related to complications were analyzed to identify significant predictors.
Twenty-two patients had IFX before surgery. The overall incidence of SSI was 47/196 (24.0 %). The incidence of infections, including SSI and other infections, was 69/196 (35.2 %). On multivariate analysis, national nosocomial infection surveillance (NNIS) risk index ≥2 (p<0.01) and preoperative prednisolone dose ≥0.2 mg/kg/day (p = 0.01) were identified as independent risk factors for overall SSI; NNIS risk index ≥2 (p <0.01) and duration from onset of UC ≥6.3 years (p = 0.045) were identified as independent risk factors for incisional SSI; contaminated wound class (p <0.01), preoperative hospital stay ≥6 days (p = 0.048), severe/fulminant disease activity (p = 0.04), and pancolitis (p = 0.02) were identified as independent risk factors for organ/space SSI; and contaminated wound (p < 0.01), severe/fulminant disease activity (p = 0.02), and age at surgery ≥43 years (p = 0.047) were identified as independent risk factors for total infectious complications.
IFX administration was not associated with infectious complications for UC surgery.
溃疡性结肠炎（UC）感染并发症发生率高，一般认为与宿主易感性相关的多种因素有关。在我们之前的研究中，大剂量皮质类固醇被认为是手术部位感染（SSI）的危险因素。最近，英夫利昔单抗（IFX）已被用于治疗难治性 UC。本研究评估了 IFX 对 UC 手术感染性并发症发生的影响，因为这一问题仍存在争议。
共纳入 2010 年 1 月至 2012 年 9 月间行剖腹手术的 196 例 UC 患者。分析可能与并发症相关的因素，以确定显著预测因子。
22 例患者术前接受过 IFX 治疗。总体 SSI 发生率为 47/196（24.0%）。感染包括 SSI 和其他感染的发生率为 69/196（35.2%）。多变量分析显示，国家医院感染监测（NNIS）风险指数≥2（p<0.01）和术前泼尼松剂量≥0.2mg/kg/天（p=0.01）是 SSI 的独立危险因素；NNIS 风险指数≥2（p<0.01）和 UC 发病≥6.3 年（p=0.045）是切口感染的独立危险因素；污染伤口分类（p<0.01）、术前住院时间≥6 天（p=0.048）、严重/暴发性疾病活动（p=0.04）和全结肠炎（p=0.02）是脏器/间隙感染的独立危险因素；污染伤口（p<0.01）、严重/暴发性疾病活动（p=0.02）和手术时年龄≥43 岁（p=0.047）是总感染性并发症的独立危险因素。
IFX 治疗与 UC 手术的感染性并发症无关。
