Coccolini Federico, Improta Mario, Cicuttin Enrico, Catena Fausto, Sartelli Massimo, Bova Raffaele, De' Angelis Nicola, Gitto Stefano, Tartaglia Dario, Cremonini Camilla, Ordonez Carlos, Baiocchi Gian Luca, Chiarugi Massimo
General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa 1, 56100, Pisa, Italy.
General Surgery Department, Bologna University Hospital, Bologna, Italy.
World J Emerg Surg. 2021 Jun 10;16(1):33. doi: 10.1186/s13017-021-00375-y.
Immunocompromised patients are at higher risk of surgical site infection and wound complications. However, optimal management in the perioperative period is not well established. Present systematic review aims to analyse existing strategies and interventions to prevent and manage surgical site infections and other wound complications in immunocompromised patients.
A systematic review of the literature was conducted.
Literature review shows that partial skin closure is effective to reduce SSI in this population. There is not sufficient evidence to definitively suggest in favour of prophylactic negative pressure wound therapy. The use of mammalian target of rapamycin (mTOR) and calcineurin inhibitors (CNI) in transplanted patient needing ad emergent or undeferrable abdominal surgical procedure must be carefully and multidisciplinary evaluated. The role of antibiotic prophylaxis in transplanted patients needs to be assessed.
Strict adherence to SSI infection preventing bundles must be implemented worldwide especially in immunocompromised patients. Lastly, it is necessary to elaborate a more widely approved definition of immunocompromised state. Without such shared definition, it will be hard to elaborate the needed methodologically correct studies for this fragile population.
免疫功能低下的患者发生手术部位感染和伤口并发症的风险更高。然而，围手术期的最佳管理方法尚未完全确立。本系统评价旨在分析现有的预防和管理免疫功能低下患者手术部位感染及其他伤口并发症的策略和干预措施。
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文献综述表明，部分皮肤缝合对于降低该人群的手术部位感染有效。没有足够的证据明确支持预防性负压伤口治疗。对于需要进行紧急或无法推迟的腹部外科手术的移植患者，使用雷帕霉素靶蛋白（mTOR）和钙调神经磷酸酶抑制剂（CNI）必须进行仔细的多学科评估。抗生素预防在移植患者中的作用需要评估。
必须在全球范围内严格遵守预防手术部位感染的综合措施，尤其是在免疫功能低下的患者中。最后，有必要制定一个更广泛认可的免疫功能低下状态的定义。没有这样一个共同的定义，就很难为这一脆弱人群开展所需的方法学正确的研究。
