Department of Infectious Diseases, Instituto Nacional de Cancerologia, Mexico City, Mexico.
MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Salvador Zubirán, Mexico City, Mexico.
Ann Surg Oncol. 2019 Nov;26(12):3883-3891. doi: 10.1245/s10434-019-07631-1. Epub 2019 Jul 25.
Breast surgery is considered a clean surgery. However, surgical-site infection (SSI) rates are currently higher than predicted. Postoperative drains remain in situ for several days, with inevitable bacterial colonization and increased SSI risk.
This randomized controlled trial from October 2016 to January 2018 analyzed patients undergoing breast cancer surgery. The patients were randomized to either the standard drain care group or the antiseptic dressing group (3M® Tegaderm® CHG). Drain samples taken on postoperative days (PODs) 7 and 14 were cultured as standardized in the laboratory. Colonization rates and SSI were compared between the two groups.
The study enrolled 104 patients with 167 surgical drains. The patients' clinical characteristics were similar in the two groups, with no statistically significant differences. Bulb fluid cultures at postoperative week (POW) 1 were positive for 42.9% of the control group and 28.9% of the antiseptic group (p = 0.06). Cultures from the POW 2 assessment were positive for 79.7% of the control group versus 54.9% of the antiseptic group (p = 0.001). Cultures from drain tubes were positive for 79.8% of the control group and 50.7% of the antiseptic group (p = < 0.001). In 11 patients, an SSI developed, 3 (5.8%) from the intervention and 8 (15.4%) from the control procedure (p = 0.11).
The study findings demonstrated that the use of antiseptics at the drain exit site significantly reduced bacterial colonization of the closed drainage system in breast cancer surgery. Semi-permeable occlusive chlorhexidine-impregnated dressings provide an opportunity to test simple, safe, and low-cost interventions that may reduce drain bacterial colonization and SSI after breast surgery.
乳腺手术被认为是一种清洁手术。然而，目前手术部位感染（SSI）的发生率高于预期。术后引流管要在体内保留数天，不可避免地会发生细菌定植，从而增加 SSI 的风险。
这是一项 2016 年 10 月至 2018 年 1 月进行的随机对照试验，分析了接受乳腺癌手术的患者。患者被随机分为标准引流护理组或抗菌敷贴组（3M® Tegaderm® CHG）。术后第 7 天和第 14 天采集引流样本进行实验室培养。比较两组的定植率和 SSI。
该研究共纳入 104 例 167 例乳腺手术患者。两组患者的临床特征相似，无统计学差异。对照组第 1 周时引流瓶内液体培养阳性率为 42.9%，抗菌组为 28.9%（p=0.06）。第 2 周时，对照组的培养阳性率为 79.7%，抗菌组为 54.9%（p=0.001）。对照组引流管培养阳性率为 79.8%，抗菌组为 50.7%（p<0.001）。共有 11 例患者发生 SSI，干预组 3 例（5.8%），对照组 8 例（15.4%）（p=0.11）。
研究结果表明，在引流出口处使用抗菌剂可显著降低乳腺癌手术后封闭引流系统的细菌定植。半透性密闭氯己定浸渍敷贴为测试简单、安全、低成本的干预措施提供了机会，这些措施可能会减少乳腺手术后引流管的细菌定植和 SSI。
