Wang Guangning, Zhang Suhong
Department of Esthetic Surgery, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China.
Department of Ophthalmology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China -
Minerva Chir. 2017 Dec;72(6):499-504. doi: 10.23736/S0026-4733.17.07295-9. Epub 2017 Feb 23.
Explore the risk factors, etiology, and drug resistance of infection after plastic surgery, and present corresponding measures.
We retrospectively analyzed 980 patients who underwent head and facial plastic surgery from January 2013 to December 2015. Postoperative infection occurred in 169 patients. We analyzed the distribution of pathogenic bacteria in patients undergoing plastic surgery, reviewed the drug resistance of Gram negative (G-) bacteria and Gram positive (G+) bacteria, and analyzed the effects of surgical duration, prophylactic use of antibacterial agents, length of stay (LOS), and preoperative hair removal on infection after plastic surgery.
G+ bacteria (mainly Staphylococcus aureus) accounted for 45.6%, while G- bacteria (mainly Pseudomonas aeruginosa and Klebsiella pneumoniae) accounted for 54.4% of total pathogenic bacteria in patients undergoing plastic surgery. The most commonly resistant antibacterial agents of Pseudomonas aeruginosa were sulfamethoxazole, ciprofloxacin, and cefotaxime; the most commonly resistant antibacterial agents of Klebsiella pneumoniae were sulfamethoxazole and gentamicin. The most commonly resistant antibacterial agents of Staphylococcus aureus were penicillin G, ampicillin, and sulfamethoxazole; for coagulase-negative staphylococcus, the most commonly resistant antibacterial agents were also penicillin G, ampicillin, and sulfamethoxazole. Both Staphylococcus aureus and coagulase-negative staphylococcus were sensitive to vancomycin and teicoplanin. Multi-factor logistic regression analysis showed that surgical duration >3 hours, no prophylactic use of antibacterial agents, and LOS>7 days were independent risk factors for postoperative infection.
G- bacteria were more prevalent in infections after plastic surgery, and most bacteria were sensitive to imipenem and meropenem. Strict control of surgical duration, short LOS, intraoperative prophylactic use of antibacterial agents, and no preoperative hair removal were important for reducing postoperative infection.
探讨整形手术后感染的危险因素、病因及耐药性，并提出相应措施。
回顾性分析2013年1月至2015年12月行头面部整形手术的980例患者。169例患者发生术后感染。分析整形手术患者病原菌分布，回顾革兰阴性（G-）菌和革兰阳性（G+）菌的耐药情况，并分析手术时长、预防性使用抗菌药物、住院时间（LOS）及术前脱毛对整形手术后感染的影响。
整形手术患者病原菌中，G+菌（主要为金黄色葡萄球菌）占45.6%，G-菌（主要为铜绿假单胞菌和肺炎克雷伯菌）占54.4%。铜绿假单胞菌最常见的耐药抗菌药物为磺胺甲恶唑、环丙沙星和头孢噻肟；肺炎克雷伯菌最常见的耐药抗菌药物为磺胺甲恶唑和庆大霉素。金黄色葡萄球菌最常见的耐药抗菌药物为青霉素G、氨苄西林和磺胺甲恶唑；凝固酶阴性葡萄球菌最常见的耐药抗菌药物也为青霉素G、氨苄西林和磺胺甲恶唑。金黄色葡萄球菌和凝固酶阴性葡萄球菌对万古霉素和替考拉宁均敏感。多因素logistic回归分析显示，手术时长>3小时、未预防性使用抗菌药物及住院时间>7天是术后感染的独立危险因素。
整形手术后感染中G-菌更为常见，多数细菌对亚胺培南和美罗培南敏感。严格控制手术时长、缩短住院时间、术中预防性使用抗菌药物及不进行术前脱毛对减少术后感染很重要。
