Zhang Xu, Li Tan, Li Yan, He Miao, Liu Ya-Qi, Wang Meng-Ying, Xin Shi-Jie, Zhao Qun
Department of Social Medicine and Health Management, China Medical University, Shenyang 110122, China.
Department of Medical Administration, the First Hospital of China Medical University, Shenyang 110001, China.
Ann Transl Med. 2019 Mar;7(5):96. doi: 10.21037/atm.2019.01.35.
Surgical site infection (SSI) has a high incidence in diabetic surgical patients. Preoperative antibiotic prophylaxis followed by an intraoperative re-dose was a common strategy in diabetic prolonged procedures. However, there were lacking studies on the relative benefits of this strategy on SSI. Our study aimed to clarify the effect of intraoperative re-dose of prophylactic antibiotics on SSI in diabetic patients.
A total of 1,840 diabetic patients with prolonged surgeries were included and Cefazolin was the only type of antibiotic prophylaxis. We assessed the relationship between intraoperative re-dose of cefazolin and 30-day incidence of SSI using a retrospective cohort study method.
There were 361 diabetic cases with preoperative antibiotics only and 1,479 cases with pre- plus intraoperative antibiotics, in which 60 subjects suffered from SSI. Pre- plus intraoperative prophylaxis group had a lower rate of SSI in the overall and subgroup analyses when compared with preoperative only group. Operation location, combined with hypertension, poor blood glucose control, high WBC count and ASA score >2 were significantly associated with an increased risk of SSI for diabetic surgical patients (all P<0.05). Intraoperative re-dose of prophylactic antibiotics was statistically related to a lower incidence rate of SSI than preoperative prophylaxis alone (crude RR =0.47; 95% CI, 0.27-0.82; P<0.01), while the association remained significant even after adjusting the potential confounders (adjusted RR =0.51; 95% CI, 0.29-0.90; P=0.02).
For diabetic patients, intraoperative re-dose of prophylactic antibiotics may be an independent protective factor for the prevention of SSI. A specific perioperative antibiotics injection strategy should be encouraged for diabetic patients with prolonged surgeries to minimize the possibility of SSI.
手术部位感染（SSI）在糖尿病手术患者中发生率较高。术前预防性使用抗生素并在术中再次给药是糖尿病患者长时间手术中的常见策略。然而，关于该策略对SSI的相对益处的研究较少。我们的研究旨在阐明术中再次预防性使用抗生素对糖尿病患者SSI的影响。
共纳入1840例接受长时间手术的糖尿病患者，头孢唑林是唯一的预防性抗生素。我们采用回顾性队列研究方法评估术中头孢唑林再次给药与SSI 30天发生率之间的关系。
仅术前使用抗生素的糖尿病病例有361例，术前加术中使用抗生素的病例有1479例，其中60例发生SSI。在总体和亚组分析中，术前加术中预防组的SSI发生率低于仅术前预防组。手术部位、合并高血压、血糖控制不佳、白细胞计数高和ASA评分>2与糖尿病手术患者SSI风险增加显著相关（均P<0.05）。术中再次预防性使用抗生素与单独术前预防相比，SSI发生率在统计学上较低（粗RR =0.47；95%CI，0.27 - 0.82；P<0.01），即使在调整潜在混杂因素后，该关联仍具有统计学意义（调整RR =0.51；95%CI，0.29 - 0.90；P =0.02）。
对于糖尿病患者，术中再次预防性使用抗生素可能是预防SSI的独立保护因素。对于接受长时间手术的糖尿病患者，应鼓励采用特定的围手术期抗生素注射策略，以尽量降低SSI的可能性。
