下颌骨骨折手术治疗术后感染并发症的单中心回顾性研究：术后使用抗生素并无益处。
A single-center retrospective review of postoperative infectious complications in the surgical management of mandibular fractures: Postoperative antibiotics add no benefit.
作者信息
Domingo Fernando, Dale Elizabeth, Gao Cuilan, Groves Cynthia, Stanley Daniel, Maxwell Robert A, Waldrop Jimmy L
机构信息
From the Department of General Surgery (F.D.), University of Tennessee College of Medicine, Chattanooga, Tennessee; Department of Plastic and Reconstructive Surgery (E.D.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Mathematics (C.G.), University of Tennessee at Chattanooga, Chattanooga, TN; University of Tennessee College of Medicine (C.G., Medical Student), Memphis, Tennessee, Department of Surgery (J.D.S.), University of Tennessee College of Medicine, Chattanooga, Tennessee, Department of Surgery (R.A.M.), University of Tennessee College of Medicine, Chattanooga, Tennessee, and Department of Plastic and Reconstructive Surgery (J.L.W.), University of Tennessee College of Medicine, Chattanooga, Tennessee.
出版信息
J Trauma Acute Care Surg. 2016 Dec;81(6):1109-1114. doi: 10.1097/TA.0000000000001232.
BACKGROUND
Mandibular fractures are common facial injuries and treatment may be complicated by post-operative infection. Risk of infection from contamination with oral flora is well established but no consensus exists regarding antibiotic prophylaxis. The purpose of this study is to assess risk factors and perioperative antibiotics on surgical site infection (SSI) rates following mandibular fracture surgery.
METHODS
Retrospective medical record review was completed for trauma patients of any age surgically treated for mandibular fractures at a Level I Trauma Center from September 2006 to June 2012. Outcomes analysis was performed to determine SSI rates related to perioperative antibiotic use and other risk factors that may contribute to SSI.
RESULTS
359 patients met inclusion criteria for analysis. 76% were male. Mean age was 30.5 years. Thirty-eight patients developed SSI (10.6%). SSI rate was lower in closed versus open surgery (3.2% vs. 16.3%, p=0.0001), and in closed versus open fractures (1% vs. 14%, p=0.0005). SSI rate increased in patients with tobacco, alcohol, and drug use (14.6%, 13.2%, 53.6%, p<0.0001), traumatic dental injuries (19.6%, p=0.0110), and patients in motor vehicle crashes (12.2%, p=0.0062). SSI rates stratified by Injury Severity Score (ISS) less than or equal to 16 (23/255 [9%]) versus ISS greater than 16 (15/104 [14%]) trended toward more severely injured patients developing SSI, p=0.1347. SSI rate was similar in patients who did and did not receive post-operative antibiotics (14.7% vs. 9.6%, p=0.2556). Type of antibiotic, duration of post-operative antibiotic administration, and duration between injury and surgery did not effect SSI rate.
CONCLUSIONS
Findings suggest that following surgical treatment of mandible fractures, open surgery, open fractures, and risk factors including substance abuse, traumatic dental injury, and mechanism of injury significantly increase SSI rates, while post-operative antibiotics do not appear to provide additional benefit compared to pre-operative antibiotics alone.
LEVEL OF EVIDENCE
Therapeutic study, level IV.
背景
下颌骨骨折是常见的面部损伤，术后感染可能会使治疗变得复杂。口腔菌群污染导致感染的风险已得到充分证实，但在抗生素预防方面尚未达成共识。本研究的目的是评估下颌骨骨折手术后手术部位感染（SSI）率的危险因素及围手术期使用抗生素的情况。
方法
对2006年9月至2012年6月在一级创伤中心接受手术治疗下颌骨骨折的各年龄段创伤患者进行回顾性病历审查。进行结果分析以确定与围手术期使用抗生素及其他可能导致SSI的危险因素相关的SSI率。
结果
359例患者符合纳入分析标准。76%为男性。平均年龄为30.5岁。38例患者发生了SSI（10.6%）。闭合性手术与开放性手术的SSI率较低（3.2%对16.3%，p = 0.0001），闭合性骨折与开放性骨折的SSI率也较低（1%对14%，p = 0.0005）。有吸烟、饮酒和吸毒史的患者SSI率升高（14.6%、13.2%、53.6%，p < 0.0001），有外伤性牙损伤的患者SSI率升高（19.6%，p = 0.0110），机动车碰撞伤患者的SSI率升高（12.2%，p = 0.0062）。根据损伤严重程度评分（ISS）分层，ISS小于或等于16的患者SSI率（23/255 [9%]）与ISS大于16的患者（15/104 [14%]）相比，重伤患者发生SSI的趋势更明显，p = 0.1347。接受和未接受术后抗生素治疗的患者SSI率相似（14.7%对9.6%，p = 0.2556）。抗生素类型、术后抗生素使用持续时间以及受伤与手术之间的时间间隔均不影响SSI率。
结论
研究结果表明，下颌骨骨折手术治疗后，开放性手术、开放性骨折以及包括药物滥用、外伤性牙损伤和损伤机制在内的危险因素会显著增加SSI率，而与单独使用术前抗生素相比，术后抗生素似乎并未提供额外益处。
证据级别
治疗性研究，四级。
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