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口服抗生素预防可降低择期结直肠手术的手术部位感染：加泰罗尼亚一项实用队列研究的结果

Oral Antibiotic Prophylaxis Lowers Surgical Site Infection in Elective Colorectal Surgery: Results of a Pragmatic Cohort Study in Catalonia.

作者信息

Badia Josep M, Flores-Yelamos Miriam, Vázquez Ana, Arroyo-García Nares, Puig-Asensio Mireia, Parés David, Pera Miguel, López-Contreras Joaquín, Limón Enric, Pujol Miquel

机构信息

Department of Surgery, Hospital General Granollers, 08348 Granollers, Barcelona, Spain.

School of Medicine, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona, Spain.

出版信息

J Clin Med. 2021 Nov 29;10(23):5636. doi: 10.3390/jcm10235636.

DOI:10.3390/jcm10235636
PMID:34884337
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8658297/
Abstract

BACKGROUND

The role of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP) in the prevention of surgical site infection (SSI) after colorectal surgery is still controversial. The aim of this study was to analyze the effect of a bundle including both measures in a National Infection Surveillance Network in Catalonia.

METHODS

Pragmatic cohort study to assess the effect of OAP and MBP in reducing SSI rate in 65 hospitals, comparing baseline phase (BP: 2007-2015) with implementation phase (IP: 2016-2019). To compare the results, a logistic regression model was established.

RESULTS

Out of 34,421 colorectal operations, 5180 had SSIs (15.05%). Overall SSI rate decreased from 18.81% to 11.10% in BP and IP, respectively (OR 0.539, CI 0.507-0.573, < 0.0001). Information about bundle implementation was complete in 61.7% of cases. In a univariate analysis, OAP and MBP were independent factors in decreasing overall SSI, with OR 0.555, CI 0.483-0.638, and OR 0.686, CI 0.589-0.798, respectively; and similarly, organ/space SSI (O/S-SSI) (OR 0.592, CI 0.494-0.710, and OR 0.771, CI 0.630-0.944, respectively). However, only OAP retained its protective effect at both levels at multivariate analyses.

CONCLUSIONS

oral antibiotic prophylaxis decreased the rates of SSI and O/S-SSI in a large series of elective colorectal surgery.

摘要

背景

口服抗生素预防（OAP）和机械肠道准备（MBP）在结直肠手术后预防手术部位感染（SSI）中的作用仍存在争议。本研究的目的是分析在加泰罗尼亚的一个国家感染监测网络中，这两种措施联合使用的效果。

方法

实用队列研究，评估OAP和MBP在65家医院降低SSI发生率的效果，将基线阶段（BP：2007 - 2015年）与实施阶段（IP：2016 - 2019年）进行比较。为比较结果，建立了逻辑回归模型。

结果

在34421例结直肠手术中，5180例发生了SSI（15.05%）。BP和IP阶段的总体SSI发生率分别从18.81%降至11.10%（OR 0.539，CI 0.507 - 0.573，P < 0.0001）。61.7%的病例中有关于联合措施实施的完整信息。在单因素分析中，OAP和MBP是降低总体SSI的独立因素，OR分别为0.555，CI 0.483 - 0.638，以及OR 0.686，CI 0.589 - 0.798；同样，器官/腔隙SSI（O/S - SSI）（OR分别为0.592，CI 0.494 - 0.710，以及OR 0.771，CI 0.630 - 0.944）。然而，在多因素分析中，只有OAP在两个层面都保持其保护作用。

结论

在一系列大型择期结直肠手术中，口服抗生素预防降低了SSI和O/S - SSI的发生率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28ea/8658297/388f042113e2/jcm-10-05636-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28ea/8658297/388f042113e2/jcm-10-05636-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28ea/8658297/388f042113e2/jcm-10-05636-g001.jpg

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Bowel decontamination before colonic and rectal surgery.结肠和直肠手术前的肠道去污。
Br J Surg. 2021 Dec 17;109(1):3-7. doi: 10.1093/bjs/znab389.
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Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial.择期结肠切除术的机械性和口服抗生素肠道准备与无肠道准备（MOBILE）：一项多中心、随机、平行、单盲试验。
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