Skender Kristina, Machowska Anna, Singh Vivek, Goel Varun, Marothi Yogyata, Lundborg Cecilia Stålsby, Sharma Megha
Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, 17177 Stockholm, Sweden.
Department of Orthopedics, Ruxmaniben Deepchand Gardi Medical College, Surasa, Ujjain 456006, India.
Antibiotics (Basel). 2022 May 31;11(6):748. doi: 10.3390/antibiotics11060748.
Orthopedic surgeries contribute to the overall surgical site infection (SSI) events worldwide. In India, SSI rates vary considerably (1.6−38%); however, there is a lack of a national SSI surveillance system. This study aims to identify the SSI incidence, risk factors, antibiotic prescription and susceptibility patterns among operated orthopedic patients in a teaching hospital in India. Data for 1205 patients were collected from 2013 to 2016. SSIs were identified based on the European Centre for Disease Prevention and Control guidelines. The American Society for Anesthesiologists classification system was used to predict patients’ operative risk. Univariable and multivariable backward stepwise logistic regressions were performed. Overall, 7.6% of patients developed SSIs over three years. The most common SSIs causative microorganism was Staphylococcus aureus (7%), whose strains were resistant to penicillin (100%), erythromycin (80%), cotrimoxazole (80%), amikacin (60%) and cefoxitin (60%). Amikacin was the most prescribed antibiotic (36%). Male sex (OR 2.64; 95%CI 1.32−5.30), previous hospitalization (OR 2.15; 95%CI 1.25−3.69), antibiotic prescription during hospitalization before perioperative antibiotic prophylaxis (OR 4.19; 95%CI 2.51−7.00) and postoperative length of stay > 15 days (OR 3.30; 95%CI 1.83−5.95) were identified as significant risk factors. Additionally, preoperative shower significantly increased the SSI risk (OR 4.73; 95%CI 2.72−8.22), which is unconfirmed in the literature so far.
骨科手术导致了全球范围内的总体手术部位感染（SSI）事件。在印度，SSI发生率差异很大（1.6%-38%）；然而，该国缺乏全国性的SSI监测系统。本研究旨在确定印度一家教学医院接受手术的骨科患者的SSI发生率、危险因素、抗生素处方及药敏模式。收集了2013年至2016年1205例患者的数据。根据欧洲疾病预防控制中心的指南确定SSI。采用美国麻醉医师协会分类系统预测患者的手术风险。进行了单变量和多变量向后逐步逻辑回归分析。总体而言，7.6%的患者在三年中发生了SSI。最常见的SSI致病微生物是金黄色葡萄球菌（7%），其菌株对青霉素（100%）、红霉素（80%）、复方新诺明（80%）、阿米卡星（60%）和头孢西丁（60%）耐药。阿米卡星是最常使用的抗生素（36%）。男性（比值比2.64；95%置信区间1.32-5.30）、既往住院史（比值比2.15；95%置信区间1.25-3.69）、围手术期抗生素预防前住院期间的抗生素处方（比值比4.19；95%置信区间2.51-7.00）以及术后住院时间>15天（比值比3.30；95%置信区间1.83-5.95）被确定为显著危险因素。此外术前淋浴显著增加了SSI风险（比值比4.73；95%置信区间2.72-8.22），这一点目前在文献中尚未得到证实。
