Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Am J Transplant. 2013 Aug;13(8):2137-45. doi: 10.1111/ajt.12292. Epub 2013 May 24.
We conducted a retrospective study of deep surgical site infections (SSIs) among consecutive patients who underwent lung transplantation (LTx) at a single center from 2006 through 2010. Thirty-one patients (5%) developed SSIs at median 25 days after LTx. Empyema was most common (42%), followed by surgical wound infections (29%), mediastinitis (16%), sternal osteomyelitis (6%), and pericarditis (6%). Pathogens included Gram-positive bacteria (41%), Gram-negative bacteria (41%), fungi (10%) and Mycobacterium abscessus, Mycoplasma hominis and Lactobacillus sp. (one each). Twenty-three percent of SSIs were due to pathogens colonizing recipients' native lungs at time of LTx, suggesting surgical seeding as a source. Patient-related independent risk factors for SSIs were diabetes and prior cardiothoracic surgery; procedure-related independent risk factors were LTx from a female donor, prolonged ischemic time and number of perioperative red blood cell transfusions. Mediastinitis and sternal infections were not observed among patients undergoing minimally invasive LTx. SSIs were associated with 35% mortality at 1 year post-LTx. Lengths of stay and mortality in-hospital and at 6 months and 1 year were significantly greater for patients with SSIs other than empyema. In conclusion, deep SSIs were uncommon, but important complications in LTx recipients because of their diverse microbiology and association with increased mortality.
我们对 2006 年至 2010 年间在一家中心接受肺移植（LTx）的连续患者的深部手术部位感染（SSI）进行了回顾性研究。31 名患者（5％）在 LTx 后中位数 25 天发生 SSI。脓胸最常见（42％），其次是手术伤口感染（29％），纵隔炎（16％），胸骨骨髓炎（6％）和心包炎（6％）。病原体包括革兰氏阳性菌（41％），革兰氏阴性菌（41％），真菌（10％）和脓肿分枝杆菌，人支原体和乳杆菌。SSI 的 23％归因于 LTx 时受体固有肺部定植的病原体，提示手术播种是感染源。与 SSI 相关的患者相关独立危险因素是糖尿病和先前的心胸外科手术；与程序相关的独立危险因素是来自女性供体的 LTx，缺血时间延长和围手术期红细胞输注次数。微创 LTx 中未观察到纵隔炎和胸骨感染。SSI 与 LTx 后 1 年的 35％死亡率相关。SSI 患者的住院时间，住院和 6 个月及 1 年的死亡率明显高于非脓胸患者。总之，深部 SSI 并不常见，但在 LTx 受者中是重要的并发症，因为其微生物学种类繁多，与死亡率增加有关。
