氯己定-酒精与聚维酮碘用于腹部子宫切除术术前局部消毒的比较

Chlorhexidine-Alcohol Compared With Povidone-Iodine for Preoperative Topical Antisepsis for Abdominal Hysterectomy.

作者信息

Uppal Shitanshu, Bazzi Ali, Reynolds R Kevin, Harris John, Pearlman Mark D, Campbell Darrell A, Morgan Daniel M

机构信息

Departments of Obstetrics & Gynecology and Surgery and the Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, and the Department of Obstetrics and Gynecology, St. John Hospital and Medical Center, Detroit, Michigan.

出版信息

Obstet Gynecol. 2017 Aug;130(2):319-327. doi: 10.1097/AOG.0000000000002130.

DOI:10.1097/AOG.0000000000002130

PMID:28697103

Abstract

OBJECTIVE

To compare preoperative chlorhexidine-alcohol topical antiseptic agent with povidone-iodine in patients undergoing abdominal hysterectomy for benign indications.

METHODS

A retrospective cohort study of patients undergoing abdominal hysterectomy from July 2012 to February 2015 in the Michigan Surgical Quality Collaborative was performed. The primary exposure was the use of chlorhexidine-alcohol or povidone-iodine. The primary outcome was surgical site infection within 30 days. Multivariable logistic regression and propensity score matching analysis were done to estimate the independent association of skin antiseptic choice on the rate of surgical site infection.

RESULTS

Of the total 4,259 abdominal hysterectomies included, chlorhexidine-alcohol was used in 70.5% (n=3,005) and povidone-iodine in 29.5% (n=1,254) of surgeries. The overall unadjusted rate of any surgical site infection was 2.9% (95% CI 2.5-3.5; n=124). The unadjusted rate of surgical site infection 2.6% (95% CI 2.1-3.3; n=79) for chlorhexidine-alcohol and 3.6% (95% CI 2.7-4.8; n=45; P=.09) for the povidone-iodine group. Using multivariate logistic regression and adjusting for differences between populations in patient demographic factors (age and body mass index), medical comorbidities (American Society of Anesthesiologists class and diabetes status), perioperative variables (estimated blood loss, surgical time, intraoperative adhesions, and antibiotic categories), and hospital characteristics (bed size and teaching status), we estimate that patients receiving chlorhexidine-alcohol had 44% lower odds of developing a surgical site infection (adjusted odds ratio 0.56, 95% CI 0.37-0.85, P=.01). Propensity score matching (one to one) yielded 808 patients in the chlorhexidine-alcohol group and 845 patients in the povidone-iodine group. In the matched groups, the rate of surgical site infection was 1.5% (95% CI 0.8-2.6; n=12) for the chlorhexidine-alcohol group and 4.7% (95% CI 3.5-6.4; n=40) for the povidone-iodine group (P<.001).

CONCLUSION

In abdominal hysterectomy performed for benign indications, chlorhexidine-alcohol-based skin antisepsis is associated with overall lower odds of surgical site infection compared with povidone-iodine.

摘要

目的

比较术前使用氯己定 - 酒精局部抗菌剂与聚维酮碘用于因良性指征行腹式子宫切除术的患者。

方法

对2012年7月至2015年2月在密歇根外科质量协作组接受腹式子宫切除术的患者进行回顾性队列研究。主要暴露因素是使用氯己定 - 酒精或聚维酮碘。主要结局是30天内手术部位感染。进行多变量逻辑回归和倾向评分匹配分析，以评估皮肤消毒剂选择与手术部位感染率之间的独立关联。

结果

在纳入的4259例腹式子宫切除术中，70.5%（n = 3005）的手术使用了氯己定 - 酒精，29.5%（n = 1254）的手术使用了聚维酮碘。任何手术部位感染的总体未调整率为2.9%（95%CI 2.5 - 3.5；n = 124）。氯己定 - 酒精组手术部位感染的未调整率为2.6%（95%CI 2.1 - 3.3；n = 79），聚维酮碘组为3.6%（95%CI 2.7 - 4.8；n = 45；P = 0.09）。使用多变量逻辑回归并调整患者人口统计学因素（年龄和体重指数）、医疗合并症（美国麻醉医师协会分级和糖尿病状态）、围手术期变量（估计失血量、手术时间、术中粘连和抗生素类别）以及医院特征（床位规模和教学状态）等人群差异后，我们估计接受氯己定 - 酒精治疗的患者发生手术部位感染的几率低44%（调整后的优势比为0.56，95%CI 0.37 - 0.85，P = 0.01）。倾向评分匹配（一对一）后，氯己定 - 酒精组有808例患者，聚维酮碘组有845例患者。在匹配组中，氯己定 - 酒精组手术部位感染率为1.5%（95%CI 0.8 - 2.6；n = 12），聚维酮碘组为4.7%（95%CI 3.5 - 6.4；n = 40）（P < 0.001）。