1 Department of Lower Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan 2 Inflammatory Bowel Disease Center, Hyogo College of Medicine, Hyogo, Japan 3 Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan.
Dis Colon Rectum. 2013 Oct;56(10):1156-65. doi: 10.1097/DCR.0b013e31829f682c.
Preoperative infliximab treatment may influence postoperative infectious complications in patients with Crohn's disease.
The aim of this study was to identify predictors of surgical site infection after surgery for Crohn's disease and evaluate the effects of preoperative infliximab administration.
We performed a prospective surveillance and review of surgical site infections.
This study was conducted in the Surgical Department of Hyogo College of Medicine.
A total of 405 consecutive patients with Crohn's disease who underwent abdominal surgery between January 2008 and December 2011 were included.
Infection was diagnosed by the infection control team. The possible risk factors were analyzed by using logistic regression analyses to determine their predictive significance.
Within the patient population, 20% of patients received infliximab, and 60% had penetrating disease. The median duration from the last infliximab infusion to surgery was 43 days (range, 4-80). The overall incidence of surgical site infection was 27%. The incidence of incisional surgical site infection was 18%, and the organ/space surgical site infection rate was 8%. In the multivariate analysis, proctectomy was the highest risk factor for all surgical site infection (OR, 3.4-11.8; p < 0.01). The administration of preoperative infliximab was not a risk factor for surgical site infection. By contrast, there was a significantly reduced risk of incisional surgical site infection in patients with penetrating disease who received infliximab (OR, 0.1; p < 0.01).
This study was a cohort study and not a randomized trial. The data analyses were performed for surgical site infections but not for other infectious complications.
Proctectomy was a high-risk factor for surgical site infection in patients with Crohn's disease. The administration of preoperative infliximab was not a risk factor for surgical site infection.
术前英夫利昔单抗治疗可能会影响克罗恩病患者的术后感染并发症。
本研究旨在确定克罗恩病手术后手术部位感染的预测因素，并评估术前英夫利昔单抗给药的影响。
我们进行了手术部位感染的前瞻性监测和回顾。
本研究在兵库医科大学外科进行。
共纳入 2008 年 1 月至 2011 年 12 月期间接受腹部手术的 405 例连续克罗恩病患者。
感染由感染控制小组诊断。使用逻辑回归分析来分析可能的危险因素，以确定其预测意义。
在患者人群中，20%的患者接受了英夫利昔单抗治疗，60%的患者患有穿透性疾病。从最后一次英夫利昔单抗输注到手术的中位时间为 43 天（范围为 4-80）。手术部位感染的总发生率为 27%。切口手术部位感染的发生率为 18%，器官/间隙手术部位感染率为 8%。在多变量分析中，直肠切除术是所有手术部位感染的最高危险因素（OR，3.4-11.8；p < 0.01）。术前使用英夫利昔单抗不是手术部位感染的危险因素。相比之下，接受英夫利昔单抗治疗的穿透性疾病患者发生切口手术部位感染的风险显著降低（OR，0.1；p < 0.01）。
本研究为队列研究，而非随机试验。数据分析针对手术部位感染，而不是其他感染并发症。
直肠切除术是克罗恩病患者手术部位感染的高危险因素。术前使用英夫利昔单抗不是手术部位感染的危险因素。
