El-Kholy Amani A, Elanany Mervat G, Sherif May M, Gad Maha A
Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University , Cairo, Egypt .
Surg Infect (Larchmt). 2018 Aug/Sep;19(6):629-633. doi: 10.1089/sur.2018.088. Epub 2018 Jul 6.
The rate of surgical site infection (SSI) in patients who undergo emergency operations is higher than in other patients. Previous studies showed an increasing role of gram- negative pathogens (GNP) in SSI. We aimed to identify GNP causing SSIs after emergency surgery, to characterize the carbapenemase-resistance genes in carbapenem-resistant pathogens (CRPs), and to identify the risk factors for SSI caused by CRP.
We conducted a one-year prospective study from September 2014 in the Emergency Hospital of Cairo University Hospitals. Surveillance for SSIs was conducted according to the case definitions of the U.S. Centers for Disease Control and Prevention. Clinical specimens from patients suspected of having SSI were collected; pathogens were identified by Bruker matrix-assisted laser desorption ionization time of flight (MALDI-TOF) mass spectometry. Antimicrobial susceptibility was tested by the VITEK-2 and E-test. Carbapenem-resistant GNPs were characterized by multiplex polymerase chain reaction for IMP, VIM, SPM, OXA-48, NDM, KPC, BIC, AIM, GIM, SIM, and DIM. Clinical data for patients with SSI infected with CRP were compared with the non-infected patients for detection of risk factors.
Surgical site infection affected 6.7% of patients who had emergency operations, and GNP represented 85% of these pathogens. Carbapenem-resistant pathogens caused 61% of the SSI, including all those caused by Acinetobacter baumannii, 70% of those caused by Pseudomonas aeruginosa, and 67% of those caused by Klebsiella pneumoniae. The PCR revealed that VIM, KPC, and NDM were the most common resistance genes. Risk factors for SSI were previous hospitalization, longer hospital stay, type of surgical incision, and abundant drainage; whereas previous hospitalization and infection by non-enteric environmental GNP were the risk factors for SSI caused by CRP.
The rate of SSIs caused by CRP was high after emergency surgery. VIM, KPC, and NDM were the most commonly found genes. Prior hospitalization and infection by non-enteric GNP were risk factors, which can be mitigated by eradication of bacterial populations in environmental reservoirs and control of transmission.
接受急诊手术患者的手术部位感染（SSI）发生率高于其他患者。既往研究表明革兰氏阴性病原体（GNP）在SSI中的作用日益增加。我们旨在确定急诊手术后导致SSI的GNP，鉴定耐碳青霉烯类病原体（CRP）中的碳青霉烯酶耐药基因，并确定由CRP引起的SSI的危险因素。
我们于2014年9月在开罗大学医院急诊医院开展了一项为期一年的前瞻性研究。根据美国疾病控制与预防中心的病例定义对SSI进行监测。收集疑似患有SSI患者的临床标本；通过布鲁克基质辅助激光解吸电离飞行时间（MALDI-TOF）质谱法鉴定病原体。采用VITEK-2和E-test检测抗菌药物敏感性。通过多重聚合酶链反应对耐碳青霉烯类GNP的IMP、VIM、SPM、OXA-48、NDM、KPC、BIC、AIM、GIM、SIM和DIM进行鉴定。将感染CRP的SSI患者的临床数据与未感染患者进行比较以检测危险因素。
手术部位感染影响了6.7%的急诊手术患者，GNP占这些病原体的85%。耐碳青霉烯类病原体导致了61%的SSI，包括所有由鲍曼不动杆菌引起的感染、70%由铜绿假单胞菌引起的感染以及67%由肺炎克雷伯菌引起的感染。聚合酶链反应显示VIM、KPC和NDM是最常见的耐药基因。SSI的危险因素包括既往住院史、住院时间较长、手术切口类型和引流量大；而既往住院史和非肠道环境GNP感染是由CRP引起的SSI的危险因素。
急诊手术后由CRP引起的SSI发生率较高。VIM、KPC和NDM是最常见的基因。既往住院史和非肠道GNP感染是危险因素，可通过消除环境储库中的细菌种群和控制传播来减轻。
