Seidelman Jessica L, Mantyh Christopher R, Anderson Deverick J
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina.
Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
JAMA. 2023 Jan 17;329(3):244-252. doi: 10.1001/jama.2022.24075.
Approximately 0.5% to 3% of patients undergoing surgery will experience infection at or adjacent to the surgical incision site. Compared with patients undergoing surgery who do not have a surgical site infection, those with a surgical site infection are hospitalized approximately 7 to 11 days longer.
Most surgical site infections can be prevented if appropriate strategies are implemented. These infections are typically caused when bacteria from the patient's endogenous flora are inoculated into the surgical site at the time of surgery. Development of an infection depends on various factors such as the health of the patient's immune system, presence of foreign material, degree of bacterial wound contamination, and use of antibiotic prophylaxis. Although numerous strategies are recommended by international organizations to decrease surgical site infection, only 6 general strategies are supported by randomized trials. Interventions that are associated with lower rates of infection include avoiding razors for hair removal (4.4% with razors vs 2.5% with clippers); decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures (0.8% with decolonization vs 2% without); use of chlorhexidine gluconate and alcohol-based skin preparation (4.0% with chlorhexidine gluconate plus alcohol vs 6.5% with povidone iodine plus alcohol); maintaining normothermia with active warming such as warmed intravenous fluids, skin warming, and warm forced air to keep the body temperature warmer than 36 °C (4.7% with active warming vs 13% without); perioperative glycemic control (9.4% with glucose <150 mg/dL vs 16% with glucose >150 mg/dL); and use of negative pressure wound therapy (9.7% with vs 15% without). Guidelines recommend appropriate dosing, timing, and choice of preoperative parenteral antimicrobial prophylaxis.
Surgical site infections affect approximately 0.5% to 3% of patients undergoing surgery and are associated with longer hospital stays than patients with no surgical site infections. Avoiding razors for hair removal, maintaining normothermia, use of chlorhexidine gluconate plus alcohol-based skin preparation agents, decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures, controlling for perioperative glucose concentrations, and using negative pressure wound therapy can reduce the rate of surgical site infections.
接受手术的患者中约有0.5%至3%会在手术切口部位或其附近发生感染。与未发生手术部位感染的手术患者相比，发生手术部位感染的患者住院时间大约要长7至11天。
如果实施适当的策略，大多数手术部位感染是可以预防的。这些感染通常是在手术时患者内源性菌群中的细菌接种到手术部位时引起的。感染的发生取决于多种因素，如患者免疫系统的健康状况、异物的存在、伤口细菌污染程度以及抗生素预防的使用。尽管国际组织推荐了众多策略来降低手术部位感染率，但只有6种通用策略得到了随机试验的支持。与较低感染率相关的干预措施包括避免使用剃须刀刮毛（使用剃须刀的感染率为4.4%，使用电动剪毛器的为2.5%）；对于高风险手术，使用鼻内抗葡萄球菌药物和抗葡萄球菌皮肤消毒剂进行去定植（去定植的感染率为0.8%，未去定植的为2%）；使用葡萄糖酸氯己定和酒精基皮肤消毒剂（葡萄糖酸氯己定加酒精的感染率为4.0%，聚维酮碘加酒精的为6.5%）；通过积极保暖措施维持正常体温，如加热静脉输液、皮肤保暖和强制热风，使体温保持在36°C以上（积极保暖的感染率为4.7%，未采取措施的为13%）；围手术期血糖控制（血糖<150mg/dL时感染率为9.4%，血糖>150mg/dL时为16%）；以及使用负压伤口治疗（使用的感染率为9.7%，未使用的为15%）。指南推荐了术前肠外抗菌药物预防的适当剂量、时机和选择。
手术部位感染影响约0.5%至3%的手术患者，与未发生手术部位感染的患者相比，住院时间更长。避免使用剃须刀刮毛、维持正常体温、使用葡萄糖酸氯己定加酒精基皮肤消毒剂、对于高风险手术使用鼻内抗葡萄球菌药物和抗葡萄球菌皮肤消毒剂进行去定植、控制围手术期血糖浓度以及使用负压伤口治疗可以降低手术部位感染率。
