Seneviratne Sheran, Hoffman Gary, Varadhan Hemalatha, Kitcher Jane, Cope Daron
Department of Head and Neck Surgery, John Hunter Hospital, Lookout Road, Lambton Heights, Newcastle, NSW, Australia.
Faculty of Medicine, University of Newcastle, Newcastle, NSW, Australia.
Eur Arch Otorhinolaryngol. 2018 May;275(5):1249-1255. doi: 10.1007/s00405-018-4921-8. Epub 2018 Mar 8.
The study was designed to assess the difference in microbiological colonisation and growth that may occur in drains, in the setting of clean-contaminated compared to clean head and neck surgery.
A prospective observational cohort study was performed. Surgical drain tips upon removal were sent for bacterial culture and the culture results were compared between clean-contaminated and clean procedures using mixed effects logistic regression. In all statistical analyses, a priori, p < 0.05 (two-tailed) was calculated to indicate statistical significance.
One hundred and ten drains were examined in both clean-contaminated and clean procedures. Drains from clean-contaminated procedures had a significantly longer time in situ (11 vs 5 days, p < 0.001). Overall, significant evidence was seen for an association between procedure type and drain growth rates: 68% of clean-contaminated procedures; and 45% of clean procedures. Although not statistically significant, there was an increase in normal skin flora contaminated drains in clean-contaminated procedures (41 vs 25%). Rates of pathogenic skin organisms (15 vs 16%) and pathogenic oropharyngeal organisms (2.9 vs 0%) were similar for clean-contaminated vs clean procedure patients.
This preliminary study demonstrated a higher rate of microbial contamination of neck drains that were placed during procedures that involved continuity with the upper aero-digestive tract and neck. Retrograde migration of skin flora along the drain is common but of no clinical significance. Similar rates of pathogenic microbial growth have been demonstrated thus far. However, selection of nosocomial pathogens due to extended antibiotic prophylaxis may pose a risk for infection.
1b.
本研究旨在评估在清洁-污染手术与清洁的头颈外科手术中，引流管内微生物定植和生长可能存在的差异。
进行了一项前瞻性观察队列研究。取出的手术引流管尖端送去进行细菌培养，并使用混合效应逻辑回归比较清洁-污染手术和清洁手术之间的培养结果。在所有统计分析中，预先设定p < 0.05（双侧）表示具有统计学意义。
在清洁-污染手术和清洁手术中均检查了110根引流管。清洁-污染手术的引流管在位时间明显更长（11天对5天，p < 0.001）。总体而言，有显著证据表明手术类型与引流管生长率之间存在关联：清洁-污染手术为68%；清洁手术为45%。虽然无统计学意义，但在清洁-污染手术中，正常皮肤菌群污染引流管的情况有所增加（41%对25%）。清洁-污染手术患者与清洁手术患者的致病性皮肤微生物（15%对16%）和致病性口咽微生物（2.9%对0%）发生率相似。
这项初步研究表明，在涉及上呼吸道消化道和颈部连续性的手术中放置的颈部引流管微生物污染率更高。皮肤菌群沿引流管逆行迁移很常见，但无临床意义。迄今为止，已证明致病性微生物生长率相似。然而，由于延长抗生素预防导致的医院病原体选择可能带来感染风险。
1b。
