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疾病控制与预防中心《2017年外科手术部位感染预防指南》:综述及相关建议

Centers for Disease Control and Prevention 2017 Guidelines for Prevention of Surgical Site Infections: Review and Relevant Recommendations.

作者信息

Keely Boyle K, Rachala Sridhar, Nodzo Scott R

机构信息

Department of Orthopaedics, State University of New York at Buffalo, Erie County Medical Center, 462 Grider Street, Buffalo, NY, 14215, USA.

Department of Orthopaedics, Buffalo General Medical Center, 100 High Street, Buffalo, NY, 14203, USA.

出版信息

Curr Rev Musculoskelet Med. 2018 Sep;11(3):357-369. doi: 10.1007/s12178-018-9498-8.

Abstract

PURPOSE OF REVIEW

The associated patient morbidity and resource-intensive nature of managing surgical site infections (SSI) has focused attention toward not only improving treatment protocols but also enhancing preventative measures. The purpose of this review was to summarize the relevant updated CDC guidelines for the prevention of SSI that were released in 2017. The CDC recommends the integration of the guidelines for improvement in quality metrics, reportable outcomes, and patient safety.

RECENT FINDINGS

The updated guidelines include generalized recommendations for parenteral antimicrobial prophylaxis, non-parenteral antimicrobial prophylaxis, glycemic control, normothermia, oxygenation, and antiseptic prophylaxis. The arthroplasty section includes recommendations for blood transfusion, systemic immunosuppressive therapy, and antibiotics during drain use. There was low-quality evidence precluding recommendations for preoperative intra-articular corticosteroid injections, orthopedic surgical space suits, and biofilm management. The recommendations provided throughout this review, including more recent guidelines from other organizations such as the AAOS and ACR, should assist clinicians in developing and/or refining surgical site prevention protocols for their patients undergoing total joint arthroplasty procedures.

摘要

综述目的

手术部位感染(SSI)相关的患者发病率以及管理的资源密集性质,不仅使人们将注意力集中在改进治疗方案上,还集中在加强预防措施上。本综述的目的是总结2017年发布的美国疾病控制与预防中心(CDC)预防SSI的相关更新指南。CDC建议将这些指南纳入质量指标、可报告结果和患者安全的改进中。

最新发现

更新后的指南包括关于胃肠外抗菌药物预防、非胃肠外抗菌药物预防、血糖控制、正常体温、氧合和抗菌预防的一般性建议。关节成形术部分包括关于输血、全身免疫抑制治疗以及引流管使用期间抗生素使用的建议。证据质量较低,无法就术前关节内注射皮质类固醇、骨科手术太空服和生物膜管理给出建议。本综述中提供的建议,包括美国矫形外科医师学会(AAOS)和美国放射学会(ACR)等其他组织的最新指南,应有助于临床医生为接受全关节置换手术的患者制定和/或完善手术部位预防方案。

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