Department of Anesthesiology Intensive Care, Pain and Emergency medicine, Nîmes University Hospital, Montpellier University, Nîmes, France.
Department of Clinical Pharmacy, Niîmes University Hospital, Niîmes, France.
PLoS One. 2019 Jan 8;14(1):e0210140. doi: 10.1371/journal.pone.0210140. eCollection 2019.
Standard operating rooms (SOR) are assumed to be the best place to prevent microbial contamination when performing tissue procurement. However, mobilizing an operating room is time and cost consuming if no organ retrieval is performed. In such case, non-operating dedicated rooms (NODR) are usually recommended by European guidelines for tissue harvesting. Performing the tissue retrieval in the Intensive care unit (ICU) when possible might be considered as it allows a faster and simpler procedure.
Our primary objective was to study the relationship between the risk of microbial contamination and the location (ICU, SOR or NODR) of the tissue retrieval in heart-beating and non-heart-beating deceased donors.
We retrospectively reviewed all deceased donors' files of the local tissue banks of Montpellier and Marseille from January 2007 to December 2014. The primary endpoint was the microbial contamination of the grafts. We built a multivariate regression model and used a GEE (generalized estimating equations) allowing us to take into account the clustered structure of our data.
2535 cases were analyzed involving 1027 donors. The retrieval took place for 1189 in a SOR, for 996 in a hospital mortuary (NODR) and for 350 in an ICU. 285 (11%) microbial contaminations were revealed. The multivariate analysis found that the location in a hospital mortuary was associated with a lower risk of contamination (OR 0.43, 95% CI [0.2-0.91], p = 0.03). A procurement performed in the ICU was not associated with a significant increased risk (OR 0.62, 95% CI [0.26-1.48], p = 0.4).
According to our results, performing tissue procurement in dedicated non-sterile rooms could decrease the rate of allograft tissue contamination. This study also suggests that in daily clinical practice, transferring patients from ICU to SOR for tissue procurement could be avoided as it does not lead to less microbial contamination.
标准手术室（SOR）被认为是进行组织获取时防止微生物污染的最佳场所。然而，如果没有进行器官获取，调动手术室是既费时又费钱的。在这种情况下，欧洲指南通常建议使用非手术专用房间（NODR）进行组织采集。如果可能的话，在重症监护病房（ICU）进行组织采集可能被认为是更快、更简单的程序。
我们的主要目的是研究在有心跳和无心跳的已故供体中，组织采集的位置（ICU、SOR 或 NODR）与微生物污染风险之间的关系。
我们回顾性地审查了 2007 年 1 月至 2014 年 12 月蒙彼利埃和马赛当地组织库的所有已故供体的档案。主要终点是移植物的微生物污染。我们建立了一个多变量回归模型，并使用广义估计方程（GEE），使我们能够考虑到数据的聚类结构。
共分析了 2535 例病例，涉及 1027 名供体。1189 例在 SOR 中进行了采集，996 例在医院太平间（NODR）进行了采集，350 例在 ICU 中进行了采集。发现 285 例（11%）存在微生物污染。多变量分析发现，在医院太平间进行采集与污染风险降低相关（OR 0.43，95%CI [0.2-0.91]，p=0.03）。在 ICU 进行采集与显著增加的风险无关（OR 0.62，95%CI [0.26-1.48]，p=0.4）。
根据我们的结果，在专用非无菌房间进行组织采集可以降低同种异体组织污染的发生率。本研究还表明，在日常临床实践中，为了进行组织采集而将患者从 ICU 转移到 SOR 可能是不必要的，因为这不会导致更少的微生物污染。
