择期足踝手术后手术部位感染的发生率和危险因素：一项回顾性研究。
Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study.
机构信息
Department of Rheumatology and Immunology, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
Department of Orthopaedic Trauma Center, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
出版信息
J Orthop Surg Res. 2020 Oct 1;15(1):449. doi: 10.1186/s13018-020-01972-4.
BACKGROUND
This study aimed to investigate the incidence of surgical site infection (SSI) in elective foot and ankle surgeries and identify the associated risk factors.
METHODS
This was designed as a retrospective study, including patients who underwent elective surgery of foot and ankle between July 2015 and June 2018. Data on demographics, comorbidities, and perioperative parameters were collected from the medical records, the laboratory report, the operation report, and the outpatient follow-up registration database. SSI was defined in accordance with the Center for Disease Control criteria. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for SSI.
RESULTS
A total of 1201 patients undergoing 1259 elective foot/ankle surgeries were included, of whom 26 (2.1%) had an SSI, representing an incidence rate of 1.3% for superficial SSI and 0.8% for deep SSI, respectively. The results for organism culture showed Pseudomonas aeruginosa in 7 cases, methicillin-resistant Staphylococcus aureus (MRSA) in 6, methicillin-susceptible Staphylococcus aureus (MSSA) in 5, methicillin-resistant coagulase-negative Staphylococci (MRCNS) in 2, Escherichia coli in 2, and Proteus mirabilis in 1 case. Five factors were identified to be independently associated with SSI, including prolonged preoperative stay (OR, 1.21; 95% CI, 1.09 to 1.30), allograft or bone substitute (OR, 3.76; 95% CI, 1.51 to 5.30), elevated FBG level (OR, 1.17; 95% CI, 1.04 to 1.26), lower ALB level (OR, 2.33; 95% CI, 1.19 to 3.05), and abnormal NEUT count (OR, 1.72; 95% CI, 1.27 to 2.12).
CONCLUSIONS
SSI following elective foot and ankle surgeries is low, but relatively high in forefoot surgeries, requiring particular attention in clinical practice. Although most not modifiable, these identified factors aid in risk assessment of SSI and accordingly stratifying patients and therefore should be kept in mind.
背景
本研究旨在调查择期足踝手术中外科部位感染（SSI）的发生率，并确定相关的危险因素。
方法
这是一项回顾性研究，纳入 2015 年 7 月至 2018 年 6 月间接受择期足踝手术的患者。从病历、实验室报告、手术报告和门诊随访登记数据库中收集人口统计学、合并症和围手术期参数的数据。SSI 的定义符合疾病控制中心的标准。采用单因素和多因素逻辑回归分析确定 SSI 的独立危险因素。
结果
共纳入 1201 例 1259 例择期足/踝手术患者，其中 26 例（2.1%）发生 SSI，浅表性 SSI 和深部 SSI 的发生率分别为 1.3%和 0.8%。病原菌培养结果显示，7 例为铜绿假单胞菌，6 例为耐甲氧西林金黄色葡萄球菌（MRSA），5 例为甲氧西林敏感金黄色葡萄球菌（MSSA），2 例为耐甲氧西林凝固酶阴性葡萄球菌（MRCNS），2 例为大肠埃希菌，1 例为奇异变形杆菌。有 5 个因素被确定为与 SSI 独立相关，包括术前住院时间延长（OR，1.21；95%CI，1.09 至 1.30）、同种异体移植物或骨替代物（OR，3.76；95%CI，1.51 至 5.30）、空腹血糖（FBG）水平升高（OR，1.17；95%CI，1.04 至 1.26）、白蛋白（ALB）水平降低（OR，2.33；95%CI，1.19 至 3.05）和中性粒细胞计数异常（OR，1.72；95%CI，1.27 至 2.12）。
结论
择期足踝手术后 SSI 的发生率较低，但前足手术的发生率相对较高，在临床实践中需要特别注意。虽然大多数因素不可改变，但这些确定的因素有助于评估 SSI 的风险，并相应地对患者进行分层，因此应牢记在心。
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