Kramer A, Pochhammer J, Walger P, Seifert U, Ruhnke M, Harnoss J C
Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 49a, 17495, Greifswald, Deutschland.
Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Stuttgart, Deutschland.
Chirurg. 2017 May;88(5):369-376. doi: 10.1007/s00104-017-0382-7.
In general surgery the etiology of surgical site infections has not significantly changed over the last 30 years. Gram-positive bacteria, e.g. coagulase negative staphylococci (CNS), Staphylococcus aureus and Enterococcus spp. as well as Gram-negative bacteria, e.g. Escherichia coli, Enterobacter spp., Klebsiella spp. and Pseudomonas aeruginosa, are the most common findings. Although in general surgery 10% of the S. aureus causing postoperative wound infections were methicillin resistant (MRSA), no cases of multidrug-resistant Gram-negative (MRGN) bacteria were reported. Yeasts (particularly Candida spp.) are rarely the pathogen causing surgical site infections (≤3%) and concomitant risk factors are typical (e.g. diabetes, chemotherapy, immunosuppression and malnutrition). Viruses are rarely the cause of surgical site infections. Transmission can occur by HBV, HCV or HIV positive surgical staff or in organ transplantations and postoperative reactivation of persistent infections is possible (especially for HBV, HCV, CMV, EBV and HIV). The principles for prevention of surgical site infections are dealt with as consequences of preoperative colonization by MRSA, methicillin-sensitive S. aureus (MSSA) and MRGN and reviewed with respect to screening, perioperative antibiotic prophylaxis and decolonization. In nosocomial peritonitis, the selection of antibiotics should consider previous antibiotic treatment. A single intra-abdominal detection of Candida spp. usually does not require antimycotic treatment in postoperatively stable and immunocompetent patients but is recommended in severe community-acquired or nosocomial peritonitis. Viral infections can be avoided by screening of organ donors and serological surveillance of surgery personnel.
在普通外科领域，过去30年手术部位感染的病因并未发生显著变化。革兰氏阳性菌，如凝固酶阴性葡萄球菌（CNS）、金黄色葡萄球菌和肠球菌属，以及革兰氏阴性菌，如大肠杆菌、肠杆菌属、克雷伯菌属和铜绿假单胞菌，是最常见的病原体。尽管在普通外科中，导致术后伤口感染的金黄色葡萄球菌有10%是耐甲氧西林的（MRSA），但未报告多药耐药革兰氏阴性（MRGN）菌感染病例。酵母菌（尤其是念珠菌属）很少成为引起手术部位感染的病原体（≤3%），且通常伴有典型的危险因素（如糖尿病、化疗、免疫抑制和营养不良）。病毒很少引发手术部位感染。传播可通过乙肝病毒（HBV）、丙肝病毒（HCV）或艾滋病毒（HIV）阳性的手术人员发生，在器官移植中也有可能发生，持续性感染术后再激活也是可能的（尤其是HBV、HCV、巨细胞病毒（CMV）、EB病毒（EBV）和HIV）。预防手术部位感染的原则是针对术前MRSA、甲氧西林敏感金黄色葡萄球菌（MSSA）和MRGN定植的后果进行处理，并在筛查、围手术期抗生素预防和去定植方面进行了综述。在医院获得性腹膜炎中，抗生素的选择应考虑既往的抗生素治疗情况。在术后病情稳定且免疫功能正常的患者中，单次腹腔内检测到念珠菌属通常不需要抗真菌治疗，但在严重的社区获得性或医院获得性腹膜炎中则建议进行治疗。通过筛查器官供体和对手术人员进行血清学监测可避免病毒感染。
