细菌移位是否会影响腹部创伤后脾切除患者的术后感染？

Does bacterial translocation influence the postoperative infections in splenectomized patients after abdominal trauma?

作者信息

Schietroma Mario, Pessia Beatrice, Colozzi Sara, Carlei Francesco, Amicucci Gianfranco

机构信息

Department of Surgery, University of L'Aquila, L'Aquila, Italy.

出版信息

Surgeon. 2018 Apr;16(2):94-100. doi: 10.1016/j.surge.2016.09.009. Epub 2017 Feb 3.

DOI:10.1016/j.surge.2016.09.009

PMID:28162908

Abstract

BACKGROUND

Some studies suggested that after abdominal trauma, postoperative infections are associated with bacterial translocation, whereas others have not replicated these findings. We have assessed the bacterial translocation and postoperative infections in patients undergoing splenectomy after abdominal trauma, using a very homogeneous study population.

METHODS

We consecutively studied, in a prospective observational clinical study, 125 patients who required urgent surgical treatment (splenectomy) following blunt abdominal trauma. For bacterial translocation identification, tissue samples were taken from liver, spleen and mesenteric lymph nodes (MLNs). Postoperative infectious complications in these patients were registered, confirmed by a positive culture obtained from the septic focus. Associations between clinical variables, bacterial translocation presence, and postoperative infection development were established.

RESULTS

Bacterial translocation was detected in 47 (37.6%) patients. Postoperative infections were present in 29 (23.2%) patients. A significant statistical difference was found between postoperative infections in patients with bacterial translocation evidence (22 of 47 patients: 46.8%) in comparison with patients without bacterial translocation (7 of 78 patients: 8.9%) (P < 0.05). After multivariate adjustment analysis: a) the bleeding ≥ 1500 mL was significantly associated with the risk of bacterial translocation and, b) bacterial translocation was significantly associated with the risk of postoperative infections. Bacterial strains isolated from infection sites were the same as those cultured in MLNs in 48.3% of the cases (n = 14 of 29).

CONCLUSIONS

There is higher risk of bacterial translocation in patients who required urgent surgical treatment (splenectomy) following blunt abdominal trauma and it is associated with a significant higher number of postoperative infections.

摘要

背景

一些研究表明，腹部创伤后，术后感染与细菌移位有关，而其他研究并未重复这些发现。我们使用非常同质的研究人群，评估了腹部创伤后接受脾切除术患者的细菌移位和术后感染情况。

方法

在一项前瞻性观察性临床研究中，我们连续研究了125例钝性腹部创伤后需要紧急手术治疗（脾切除术）的患者。为了鉴定细菌移位，从肝脏、脾脏和肠系膜淋巴结（MLN）采集组织样本。记录这些患者的术后感染并发症，并通过从感染灶获得的阳性培养结果进行确认。确定临床变量、细菌移位的存在与术后感染发生之间的关联。

结果

47例（37.6%）患者检测到细菌移位。29例（23.2%）患者发生术后感染。有细菌移位证据的患者术后感染率（47例中的22例：46.8%）与无细菌移位的患者（78例中的7例：8.9%）相比，存在显著统计学差异（P<0.05）。多因素调整分析后：a）出血≥1500 mL与细菌移位风险显著相关，b）细菌移位与术后感染风险显著相关。48.3%的病例（29例中的14例）中，从感染部位分离出的细菌菌株与在MLN中培养的菌株相同。