降低小儿造口关闭术后手术部位感染率。

Decreasing surgical site infections in pediatric stoma closures.

机构信息

Center of Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH.

State University of New York University at Buffalo, Department of General Surgery, Buffalo, NY.

出版信息

J Pediatr Surg. 2020 Jan;55(1):90-95. doi: 10.1016/j.jpedsurg.2019.09.058. Epub 2019 Oct 24.

DOI:10.1016/j.jpedsurg.2019.09.058

PMID:31704044

Abstract

INTRODUCTION

Gastrointestinal (GI) operations represent a significant proportion of the surgical site infection (SSI) burden in pediatric patients, resulting in significant morbidity. We have previously demonstrated that a GI bundle decreases SSI rates, length of stay (LOS), and hospital charges. Following this success, we hypothesized that by targeting the preoperative antibiotics for stoma closures based on organisms found in infected wounds, we could further decrease SSI rates.

METHODS

As part of a broad quality improvement effort to reduce SSI rates, we reviewed the responsible pathogens and their sensitivities as well as the preoperative antibiotic used, and found that 15% of wound infections were caused by enterococcus. Based on this information, starting in April 2017, we changed the prior preoperative antibiotic cefoxitin to ampicillin-sulbactam, which more accurately targeted the prevalent pathogens from April 2017 to October 2018.

RESULTS

The baseline SSI rate for all stoma takedown patients was 21.4% (25 of 119). After bundle implementation, this decreased to 7.9% (17 of 221; p = 0.03) over a period of 2.5 years. Then, after changing the preoperative antibiotics, our rate of SSI decreased further to 2.2% (1 of 44; p = 0.039) over a period of 1.5 years.

CONCLUSION

Significant reduction of SSI in GI surgery can be accomplished with several prevention strategies (our GI bundle). Then a change of the preoperative antibiotic choice, chosen based on causative wound infection organisms, may further decrease SSI rates. We recommend an institution specific analysis of wound infections and modification of preoperative antibiotics if the responsible organisms are resistant to the original antibiotic choice.

TYPE OF STUDY

Retrospective cohort study.

LEVEL OF EVIDENCE

Level III.

摘要

引言

胃肠道（GI）手术在小儿患者的手术部位感染（SSI）负担中占很大比例，导致发病率显著增加。我们之前已经证明，GI 捆绑可以降低 SSI 发生率、住院时间（LOS）和住院费用。在此成功的基础上，我们假设通过针对感染伤口中发现的病原体对造口关闭的术前抗生素进行靶向治疗，可以进一步降低 SSI 发生率。

方法

作为降低 SSI 发生率的广泛质量改进工作的一部分，我们回顾了负责病原体及其敏感性以及术前使用的抗生素，发现 15%的伤口感染是由肠球菌引起的。基于此信息，从 2017 年 4 月开始，我们将先前的术前抗生素头孢西丁改为氨苄西林-舒巴坦，这更准确地针对 2017 年 4 月至 2018 年 10 月期间的主要病原体。

结果

所有造口切除患者的基线 SSI 发生率为 21.4%（119 例中的 25 例）。在捆绑实施后，经过 2.5 年的时间，这一比例下降到 7.9%（221 例中的 17 例；p=0.03）。然后，在改变术前抗生素后，我们的 SSI 发生率在 1.5 年内进一步降至 2.2%（44 例中的 1 例；p=0.039）。