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结直肠手术后手术部位感染的风险和最常见的分离病原体:一项前瞻性单中心观察性研究。

Risk of surgical site infections after colorectal surgery and the most frequent pathogens isolated: a prospective single-centre observational study.

机构信息

Department of Internal Medicine and Infectious Diseases, University General Hospital, Patras, Greece.

Department of General Surgery, University General Hospital, Patras, Greece.

出版信息

Med Glas (Zenica). 2021 Aug 1;18(2):438-443. doi: 10.17392/1348-21.

Abstract

Aim To identify risk factors for developing surgical site infections (SSIs) based on a prospective study of patients undergoing colorectal surgery. Methods Between November 2019 and January 2021, 133 patients underwent elective operation for colorectal cancer in our institution. The following variables were recorded for each patient: age, gender, body mass index (BMI), American Society of Anesthesiologists Classification (ASA class), duration of surgery, wound classification, skin preparation regimens, surgical approach, comorbidities (hypertension, diabetes, cardiovascular disease, respiratory disease, chronic steroid use), and pathogens responsible for surgical site infection. Univariate analysis was performed using χ2 tests for categorical variables. Results A total of 65 males and 68 females were enrolled. Postoperative SSI was diagnosed in 29 (21.8%) cases. Fifty five patients were >70 years old, and SSIs were significantly more frequent in this group (p=0.033). There were 92 patients with BMI <30kg/m2 and 87 with ASA class ≤2; SSIs occurred significantly less frequently in these patients (p=0.021 and p=0.028, respectively). Open surgery was performed in 113 patients; 35 (out of 113; 31%) wound infections were classified as contaminated or dirty, and SSI occurred more often in these two groups (p=0.048 and p=0.037, respectively). Nineteen patients had diabetes and 36 used steroids continuously; SSI was significantly more frequent in these patients (p=0.021 and p=0.049, respectively). Conclusion Following colorectal cancer procedures SSIs were significantly more common among patients over 70 years old, BMI≥30kg/m2 , ASA score>2, with diabetes and chronic steroid use, undergoing open, dirty or contaminated surgery. and spp. were the two most common pathogens isolated.

摘要

目的

通过对行结直肠手术患者的前瞻性研究,确定手术部位感染(SSI)的危险因素。

方法

2019 年 11 月至 2021 年 1 月,我院对 133 例择期行结直肠癌手术的患者进行了研究。记录每位患者的以下变量:年龄、性别、体重指数(BMI)、美国麻醉医师协会分级(ASA 分级)、手术时间、伤口分类、皮肤准备方案、手术入路、合并症(高血压、糖尿病、心血管疾病、呼吸系统疾病、慢性类固醇使用)以及导致手术部位感染的病原体。采用 χ2 检验对分类变量进行单因素分析。

结果

共纳入 65 例男性和 68 例女性患者。术后诊断 SSI 29 例(21.8%)。55 例患者年龄>70 岁,该组 SSI 发生率显著更高(p=0.033)。BMI<30kg/m2 患者 92 例,ASA 分级≤2 患者 87 例;这两组患者的 SSI 发生率显著较低(p=0.021 和 p=0.028)。113 例患者行开放性手术;其中 35 例(113 例中的 31%)伤口感染被归类为污染或脏污,这两组患者的 SSI 发生率更高(p=0.048 和 p=0.037)。19 例患者患有糖尿病,36 例患者持续使用类固醇;这两组患者的 SSI 发生率显著更高(p=0.021 和 p=0.049)。

结论

结直肠癌手术后,70 岁以上、BMI≥30kg/m2、ASA 评分>2、合并糖尿病和慢性类固醇使用、行开放性、污染或脏污手术的患者 SSI 发生率显著更高。金黄色葡萄球菌和凝固酶阴性葡萄球菌是分离出的两种最常见的病原体。

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