Krezalek Monika A, Alverdy John C
Division of Gastrointestinal and General Surgery, Department of Surgery, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, Illinois.
Sarah and Harold Lincoln Thompson Professor of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
Clin Colon Rectal Surg. 2023 Jan 19;36(2):133-137. doi: 10.1055/s-0043-1760719. eCollection 2023 Mar.
Despite advances in antisepsis techniques, surgical site infection remains the most common and most costly reason for hospital readmission after surgery. Wound infections are conventionally thought to be directly caused by wound contamination. However, despite strict adherence to surgical site infection prevention techniques and bundles, these infections continue to occur at high rates. The contaminant theory of surgical site infection fails to predict and explain most postoperative infections and still remains unproven. In this article we provide evidence that the process of surgical site infection development is far more complex than what can be explained by simple bacterial contamination and hosts' ability to clear the contaminating pathogen. We show a link between the intestinal microbiome and distant surgical site infections, even in the absence of intestinal barrier breach. We discuss the Trojan-horse mechanisms by which surgical wounds may become seeded by pathogens from within one's own body and the contingencies that need to be met for an infection to develop.
尽管防腐技术取得了进展，但手术部位感染仍然是手术后医院再入院最常见且成本最高的原因。传统上认为伤口感染是由伤口污染直接引起的。然而，尽管严格遵守手术部位感染预防技术和综合措施，这些感染仍以高发生率持续出现。手术部位感染的污染物理论无法预测和解释大多数术后感染，并且仍然未得到证实。在本文中，我们提供证据表明，手术部位感染的发展过程远比简单的细菌污染和宿主清除污染病原体的能力所能解释的更为复杂。我们展示了肠道微生物群与远处手术部位感染之间的联系，即使在没有肠道屏障破坏的情况下也是如此。我们讨论了特洛伊木马机制，通过该机制手术伤口可能被来自自身身体内部的病原体播种，以及感染发生所需满足的意外情况。
