Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany.
Department of Gastroenterology, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany.
Surg Infect (Larchmt). 2022 May;23(4):372-379. doi: 10.1089/sur.2021.154. Epub 2022 Mar 9.
Surgical site infections (SSIs) are a common complication in visceral surgery. Pathogens causing SSIs vary depending on the type of surgery. Within the scope of the Reduction of Postoperative Wound Infections by Antiseptica (RECIPE) trial we analyzed the pathogens cultured in intra-operative, subcutaneous swabs and in swabs from SSI in a single-center, prospective, randomized controlled study. Definition of SSI complied with the criteria of the U.S. Centers for Disease Control and Prevention (CDC). The overall rate of SSI was 28.2% in 393 patients. Colorectal surgery was performed in 68.2% of elective laparotomies. Pathogens were more often detected in intra-operative subcutaneous swabs in patients who developed SSIs than in patients who did not develop SSIs (64.4% vs. 38.0%; p < 0.001). Enterococci were found in 29.1% of intra-operative swabs in patients with SSIs, followed by in 15.5%. A higher rate of was found in patients with anemia versus those without anemia (9.2% vs. 2.3%; p = 0.006) and in patients who smoked versus those who did not (11.8% vs. 3.6%; p = 0.008). A positive subcutaneous swab (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.47-4.29; p = 0.001), pre-operative anemia (OR, 1.84; 95% CI, 1.08-3.13; p = 0.016), and renal insufficiency (OR, 2.15; 95% CI, 1.01-4.59; p = 0.048) were risk factors for SSIs. There is an association between the intra-operative detection of pathogens in subcutaneous tissue and the development of SSIs in visceral surgery. The most prevalent pathogens causing SSIs were enterococci and . More efforts are justified to reduce subcutaneous colonization with pathogens, for example by using intra-operative wound irrigation with polyhexanide solution. This trial is registered at www.ClinicalTrials.gov (ID: NCT04055233).
手术部位感染（SSI）是内脏手术的常见并发症。引起 SSI 的病原体因手术类型而异。 在 Reduction of Postoperative Wound Infections by Antiseptica（RECIPE）试验的范围内，我们在一项单中心、前瞻性、随机对照研究中分析了术中、皮下拭子和 SSI 拭子培养的病原体。SSI 的定义符合美国疾病控制与预防中心（CDC）的标准。 393 例患者中 SSI 的总发生率为 28.2%。择期剖腹手术中，结肠直肠手术占 68.2%。发生 SSI 的患者术中皮下拭子中病原体的检出率高于未发生 SSI 的患者（64.4%比 38.0%；p<0.001）。在发生 SSI 的患者中，术中拭子中发现肠球菌的比例为 29.1%，其次为 15.5%。贫血患者的检出率高于无贫血患者（9.2%比 2.3%；p=0.006），吸烟患者高于不吸烟患者（11.8%比 3.6%；p=0.008）。阳性皮下拭子（比值比[OR]，2.51；95%置信区间[CI]，1.47-4.29；p=0.001）、术前贫血（OR，1.84；95%CI，1.08-3.13；p=0.016）和肾功能不全（OR，2.15；95%CI，1.01-4.59；p=0.048）是 SSI 的危险因素。在内脏手术中，术中皮下组织病原体的检测与 SSI 的发生之间存在关联。引起 SSI 的最常见病原体是肠球菌和 。有理由进一步努力减少病原体对皮下组织的定植，例如使用聚己定溶液进行术中伤口冲洗。该试验在 www.ClinicalTrials.gov（ID：NCT04055233）注册。
