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犬口腔颌面肿瘤手术后手术部位感染的发生率及危险因素

Incidence and Risk Factors for Surgical Site Infections Following Oromaxillofacial Oncologic Surgery in Dogs.

作者信息

Rigby Brittney E, Malott Kevin, Hetzel Scott J, Soukup Jason W

机构信息

Department of Surgical Science, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States.

Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, United States.

出版信息

Front Vet Sci. 2021 Oct 18;8:760628. doi: 10.3389/fvets.2021.760628. eCollection 2021.

Abstract

Antibiotic stewardship in veterinary medicine is essential to help prevent resistant bacterial infections. Critical evaluation into the benefits of prophylactic use of antibiotics during veterinary surgical procedures is under reported and additional investigation is warranted. The objectives of this paper were to determine the incidence of surgical site infection in dogs that underwent oromaxillofacial oncologic surgery and to identify risk factors for the development of surgical site infection. In this retrospective cohort study including 226 dogs surgically treated for oromaxillofacial tumors between January 1, 1997 and December 31, 2018, the incidence of surgical site infection was determined to be 7.5%. Univariable logistical regression models were used to evaluate potential risk factors for development of surgical site infections including signalment, tumor type, antibiotic protocol, time under anesthesia, location of surgical procedure (dental suite vs. sterile operating room), specific comorbidities, and surgical margins obtained. Anesthetic events lasting greater than 6 h were significantly associated with development of infection. Signalment, comorbidities, administration of anti-inflammatory and immunosuppressive medications, tumor type, histological margin evaluation, surgical procedure location, and antibiotic protocols were not significant contributors to development of infection. Use of antibiotic therapy in this cohort was not protective against development of infection and may not be routinely indicated for all oromaxillofacial oncologic surgeries despite common promotion of its use and the contaminated nature of the oral cavity. Anesthetic time significantly contributed towards the development of infection and use of perioperative antibiotics for surgical procedures lasting >6 h may be routinely warranted.

摘要

兽医领域的抗生素管理对于预防耐药细菌感染至关重要。关于兽医外科手术中预防性使用抗生素的益处的批判性评估报道较少,因此有必要进行更多研究。本文的目的是确定接受口腔颌面肿瘤手术的犬只手术部位感染的发生率,并确定手术部位感染发生的风险因素。在这项回顾性队列研究中,纳入了1997年1月1日至2018年12月31日期间接受口腔颌面肿瘤手术治疗的226只犬只,确定手术部位感染的发生率为7.5%。使用单变量逻辑回归模型评估手术部位感染发生的潜在风险因素,包括特征、肿瘤类型、抗生素使用方案、麻醉时间、手术位置(牙科诊室与无菌手术室)、特定合并症以及手术切缘情况。持续时间超过6小时的麻醉事件与感染发生显著相关。特征、合并症、抗炎和免疫抑制药物的使用、肿瘤类型、组织学切缘评估、手术位置以及抗生素使用方案并非感染发生的显著影响因素。在该队列中使用抗生素治疗并不能预防感染发生,尽管口腔具有污染性且抗生素的使用较为普遍,但对于所有口腔颌面肿瘤手术可能并非都需常规使用抗生素。麻醉时间是感染发生的重要影响因素,对于持续时间>6小时的手术,围手术期常规使用抗生素可能是必要的。

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Vet Clin North Am Small Anim Pract. 2011 Sep;41(5):1041-56, viii. doi: 10.1016/j.cvsm.2011.05.010.

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