Department of Surgery, Amphia Hospital, Breda, The Netherlands.
Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands; Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
Int J Surg. 2015 Feb;14:85-9. doi: 10.1016/j.ijsu.2015.01.011. Epub 2015 Jan 19.
The management of surgical site infections (SSI's) in vascular surgery has been challenging over the years. To assess the outcomes associated with the various strategies, we performed a review of all SSI's after elective vascular procedures in patients with moderate to severe peripheral arterial disease in a single centre hospital.
All patients with a SSI after peripheral vascular surgery were retrieved from a database on Surgical site infections (SSI)-surveillance after vascular surgery between March 2009 and January 2012. At admission, all patients were approached by microbiological wound sampling and empirical start of antibiotics. Further wound management was based on personal experience and preference of the attending vascular surgeon. Endpoints were treatment success (complete wound healing while staying alive and without major amputation), survival and major amputation during one year follow up.
A total of 40 patients with a SSI were identified (60% superficial SSI and 40% deep SSI). In 92% of the patients with a superficial SSI's were successfully treated with adjusted antibiotics and incisional drainages. In the contrast, 25% of the patients with deep-SSI's were successfully treated. No particular treatment was more successful than the others.
Adjusted antibiotic use and adequate wound drainage are sufficient strategies for superficial SSI management. The management of deep-SSI's is a challenging undertaking and future research on indications and timing of these wide arrays of treatment options is suggested.
多年来，血管外科手术部位感染（SSI）的管理一直具有挑战性。为了评估各种策略相关的结果，我们对一家中心医院中度至重度外周动脉疾病患者的择期血管手术后所有 SSI 进行了回顾性分析。
从 2009 年 3 月至 2012 年 1 月期间血管手术后手术部位感染（SSI）监测数据库中检索出所有发生外周血管手术后 SSI 的患者。入院时，对所有患者进行微生物学伤口采样，并开始经验性使用抗生素。进一步的伤口管理基于个人经验和主治血管外科医生的偏好。主要终点为治疗成功（完全愈合伤口，患者存活且无重大截肢）、生存和一年随访期间的主要截肢。
共确定了 40 例 SSI 患者（60%为浅表 SSI，40%为深部 SSI）。在 92%的浅表 SSI 患者中，调整抗生素和切开引流治疗成功。相比之下，深部 SSI 患者中只有 25%治疗成功。没有特定的治疗方法比其他方法更成功。
调整抗生素使用和充分的伤口引流是浅表 SSI 管理的有效策略。深部 SSI 的管理是一项具有挑战性的工作，建议进一步研究这些广泛治疗选择的适应证和时机。
