Abreu Diego, Campos Enrique, Seija Verónica, Arroyo Carlos, Suarez Ruben, Rotemberg Pablo, Guillama Fernanda, Carvalhal Gustavo, Campolo Horacio, Machado Miguel, Decia Ricardo
1 Department of Urology, Pasteur Hospital , Montevideo, Uruguay .
Surg Infect (Larchmt). 2014 Dec;15(6):763-7. doi: 10.1089/sur.2013.174.
Surgical site infection (SSI) is the second most common type of nosocomial infections in the United States. In Uruguay, the incidence after prostatectomies is 2.6%. The aim of our study was to compare the efficacy of two skin antiseptics and to determine possible risk factors for SSI in patients undergoing surgery for benign prostatic hyperplasia (BPH).
A randomized trial included 70 patients operated on for BPH, of whom 56 (80%) underwent open surgery. Patients were treated by the same surgical team in a tertiary general hospital that is a referral center for patients with urologic diseases. Skin antisepsis was performed randomly using either 0.5% povidone-iodine or chlorhexidine in an alcohol base (Chemisol(®)). Possible risk factors investigated were age, renal dysfunction, bladder stones, preoperative urinary catheter, positive preoperative urine culture, operative time and technique, and vesicocutaneous fistula.
Of all patients, 41 (59%) had a urinary catheter preoperatively. Urine cultures were positive in 31 patients, of whom 29 (94%) had a urinary catheter. Surgical site infection occurred in 10 patients (18%), and 100% of the causative microorganisms were gram-negative bacteria characteristic of the urinary flora. The type of antiseptic did not affect the risk of SSI (p=1.00). The most important risk factor for infection was the presence of a urinary catheter preoperatively (p=0.003); also significant were the formation of a vesicocutaneous fistula (p=0.008), increasing age (p=0.02), and the presence of a positive preoperative urine culture (p=0.03).
In a cohort of patients submitted to open prostatectomy, SSI was not related to the type of antiseptic. The main risk factor was the presence of a urinary catheter preoperatively. All microorganisms isolated from the SSIs were characteristic of urinary tract infections.
手术部位感染（SSI）是美国第二常见的医院感染类型。在乌拉圭，前列腺切除术后的发生率为2.6%。我们研究的目的是比较两种皮肤消毒剂的疗效，并确定良性前列腺增生（BPH）手术患者发生SSI的可能危险因素。
一项随机试验纳入了70例接受BPH手术的患者，其中56例（80%）接受了开放手术。患者由一家三级综合医院的同一手术团队治疗，该医院是泌尿系统疾病患者的转诊中心。皮肤消毒随机使用0.5%聚维酮碘或酒精基氯己定（Chemisol®）。研究的可能危险因素包括年龄、肾功能不全、膀胱结石、术前导尿管、术前尿培养阳性、手术时间和技术以及膀胱皮肤瘘。
所有患者中，41例（59%）术前留置导尿管。31例患者尿培养阳性，其中29例（94%）留置导尿管。10例患者（18%）发生手术部位感染，所有致病微生物均为泌尿菌群特征性的革兰氏阴性菌。消毒剂类型不影响SSI风险（p=1.00）。感染的最重要危险因素是术前留置导尿管（p=0.003）；膀胱皮肤瘘的形成（p=0.008）、年龄增加（p=0.02）和术前尿培养阳性（p=0.03）也具有统计学意义。
在接受开放性前列腺切除术的患者队列中，SSI与消毒剂类型无关。主要危险因素是术前留置导尿管。从SSI中分离出的所有微生物均为尿路感染的特征性微生物。
