Isgren C M, Salem S E, Archer D C, Worsman F C F, Townsend N B
Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK.
Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zakazik, Egypt.
Equine Vet J. 2017 Jan;49(1):39-44. doi: 10.1111/evj.12564. Epub 2016 Feb 4.
Surgical site infection (SSI) is an important cause of post operative morbidity following laparotomy.
To investigate risk factors for SSI, including effect of season and surgery performed outside normal working hours, and to report bacterial isolates and antimicrobial resistance patterns.
Retrospective cohort study.
Data were obtained from horses that had undergone exploratory laparotomy over a 3-year period (2010-2013) in a UK hospital population. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration that developed during hospitalisation. Multivariable logistic regression was used to identify associations between pre-, intra- and post operative variables and altered likelihood of SSI.
Surgical site infection developed in 73/287 (25.4%) horses during hospitalisation. Horses of greater bodyweight (odds ratio [OR] 1.002, 95% confidence interval [CI] 1.0002-1.005, P = 0.03), increased packed cell volume (≥48%) on admission (OR 3.03, 95% CI 1.32-6.94, P = 0.01), small intestinal resection (OR 2.27, 95% CI 1.15-4.46, P = 0.02) and post operative colic (OR 2.86, 95% CI 1.41-5.79, P = 0.003) were significantly associated with increased likelihood of SSI in a multivariable model. SSI was also significantly more likely to occur during winter (OR 3.84, 95% CI 1.38-10.70, P = 0.01) and summer (OR 5.63, 95% CI 2.07-15.3, P = 0.001) months in the model. Three-layer closure of the incision was protective (OR 0.31, 95% CI 0.16-0.58, P<0.001) compared to 2-layer closure. There was no effect of surgery being performed outside normal working hours (P = 0.5). The most common bacterial isolates were Escherichia coli (59.5%), Enterococcus spp. (42.4%) and Staphylococcus spp. (25.4%). Penicillin resistant isolates accounted for 92% (96/104) of isolates while 18% (21/119) of isolates were gentamicin resistant.
Laparotomy during winter and summer months was associated with increased likelihood of SSI but there was no effect of surgery performed outside normal working hours. This information assists in identifying horses at high risk of SSI and informing development of preventive strategies.
手术部位感染（SSI）是剖腹术后发病的重要原因。
调查SSI的危险因素，包括季节及非正常工作时间进行手术的影响，并报告细菌分离株及抗菌药物耐药模式。
回顾性队列研究。
数据来源于英国一家医院3年期间（2010 - 2013年）接受剖腹探查术的马匹。SSI定义为住院期间剖腹手术切口出现的持续时间>24小时的任何脓性或浆液性分泌物。采用多变量逻辑回归分析术前、术中和术后变量与SSI发生可能性改变之间的关联。
73/287（25.4%）匹马在住院期间发生手术部位感染。在多变量模型中，体重较大的马匹（比值比[OR]1.002，95%置信区间[CI]1.0002 - 1.005，P = 0.03）、入院时红细胞压积升高（≥48%）（OR 3.03，95% CI 1.32 - 6.94，P = 0.01）、小肠切除术（OR 2.27，95% CI 1.15 - 4.46，P = 0.02）和术后腹痛（OR 2.86，95% CI 1.41 - 5.79，P = 0.003）与SSI发生可能性增加显著相关。在该模型中，SSI在冬季（OR 3.84，95% CI 1.38 - 10.70，P = 0.01）和夏季（OR 5.63，95% CI 2.07 - 15.3，P = 0.001）月份发生的可能性也显著更高。与两层缝合相比，切口三层缝合具有保护作用（OR 0.31，95% CI 0.16 - 0.58，P<0.001）。非正常工作时间进行手术无影响（P = 0.5）。最常见的细菌分离株为大肠杆菌（59.5%）、肠球菌属（42.4%）和葡萄球菌属（25.4%）。耐青霉素分离株占分离株的92%（96/104），而耐庆大霉素分离株占18%（21/119）。
冬季和夏季进行剖腹手术与SSI发生可能性增加相关，但非正常工作时间进行手术无影响。该信息有助于识别SSI高危马匹并为制定预防策略提供依据。
