Clinical Microbiology Registrar, Department of Microbiology, Auckland District Health Board, Auckland City Hospital, Auckland.
Clinical Microbiologist and Infectious Disease Physician, Department of Microbiology, Auckland District Health Board, Auckland City Hospital, Auckland; Clinical Lead, Infection Prevention and Control Programme, Health Quality & Safety Commission, Wellington.
N Z Med J. 2022 Feb 25;135(1550):47-61.
To describe risk factors for surgical site infection (SSI) caused by aerobic Gram-negative organisms after hip and knee arthroplasty.
Publicly funded hip and knee arthroplasties (performed between 1 July 2013 and 31 December 2017) that developed SSIs were compared to those that did not. SSIs were grouped by causative organism: Gram-negative (Pseudomonas spp. or enteric Gram-negative bacilli) or staphylococcal (pure or mixed growth of Staphylococcus spp.). Independent risk factors in each group were identified.
24,842 (54%) hip and 20,993 (46%) knee arthroplasties were performed. There were 497 (1.1%) SSIs. Staphylococci were responsible for 233 SSIs (47%) and Gram-negatives were responsible for 73 (15%). Age, sex, body mass index ≥35kg/m2, smoking status, socioeconomic deprivation, American Society of Anesthesiologists classification, revision surgery and prophylactic antibiotic dose were all independent predictors of all-cause SSI. On subgroup analysis, socioeconomic deprivation and Pasifika ethnicity were independent risk factors for Gram-negative SSI, but not staphylococcal SSI.
In this study, socioeconomic deprivation and ethnicity were independent and novel risk factors for Gram-negative SSI following arthroplasty. Some of the SSI risk factors can be modified before arthroplasty (e.g., appropriate timing of prophylactic antibiotics, smoking cessation, weight loss). Non-modifiable risk factors can help identify high-risk procedures where additional pre- and post-operative interventions may be warranted.
描述髋膝关节置换术后由需氧革兰氏阴性菌引起的手术部位感染（SSI）的危险因素。
对比分析 2013 年 7 月 1 日至 2017 年 12 月 31 日期间接受全髋关节和全膝关节置换术且发生 SSI 的患者和未发生 SSI 的患者。根据病原菌将 SSI 分为革兰氏阴性菌（铜绿假单胞菌或肠杆菌科革兰氏阴性杆菌）和葡萄球菌（金黄色葡萄球菌或混合生长的金黄色葡萄球菌）。对每组的独立危险因素进行鉴定。
共实施 24842 例髋关节置换术（54%）和 20993 例膝关节置换术（46%）。共发生 497 例 SSI（1.1%）。葡萄球菌导致 233 例 SSI（47%），革兰氏阴性菌导致 73 例 SSI（15%）。年龄、性别、体重指数≥35kg/m2、吸烟状况、社会经济剥夺、美国麻醉医师协会分级、翻修手术和预防性抗生素剂量均是所有 SSI 的独立预测因素。亚组分析显示，社会经济剥夺和太平洋岛裔是革兰氏阴性菌 SSI 的独立危险因素，但不是葡萄球菌 SSI 的独立危险因素。
在这项研究中，社会经济剥夺和种族是关节置换术后革兰氏阴性菌 SSI 的独立且新颖的危险因素。一些 SSI 危险因素可以在关节置换术前进行修正（例如，预防性抗生素的适当时机、戒烟、减肥）。不可修正的危险因素可以帮助识别高风险手术，这些手术可能需要额外的围手术期干预措施。
