Vishnoi Veral, Morey Tristan, Hoedt Emily C, Keely Simon, Pockney Peter, Smith Stephen R
School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.
Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
Surg Infect (Larchmt). 2023 May;24(4):293-302. doi: 10.1089/sur.2023.012. Epub 2023 Mar 24.
Surgical site infection remains a significant cause of morbidity and mortality. Traditionally, the causation has been inferred from the organism(s) detected in the post-operative setting. However, the intra-operative surgical site and the bacteria it harbors have been scarcely studied. Compared with culture-dependent methods, the development of genomic technology provides a new sensitive tool that could aid in characterizing the bacteria within the surgical site. The purpose of this literature review is to establish if there is a predictive role of sampling the intra-operative surgical site. A systematic literature review was conducted identifying relevant literature reporting on studies that sampled the intra-operative surgical site of any specialty, using either traditional culture or a culture-independent genomic sequencing-based technique and correlation with infection was attempted. The review identified studies between 1959 and 2021 in MEDLINE, EMBASE and Cochrane. The initial search identified 7,835 articles; 36 remained after screening. Thirty-one articles focused on culture-dependent techniques, five on culture-independent. Subgroup meta-analysis demonstrates that a positive intra-operative culture carries a risk of downstream infection with an odds ratio of 8.6, however limited by a high false-positive and inability to correlate the intra-operative culture with the post-operative infection. In contrast, culture-independent studies through genomic sequencing are not predictive but suggest that the surgical incision is a complex microbial community with a shift toward dysbiosis in certain patients. The intra-operative surgical site clearly harbors bacteria. Both techniques give rise to separate explanations underpinning the role of bacteria in surgical site infection. It is possible there is a more complex dynamic community within the incision that makes a patient susceptible to infection. Characterizing this microbial community in large scale studies, including patients with infections may enhance our ability to predict and prevent incisional surgical site infections in patients undergoing surgical procedures.
手术部位感染仍然是发病和死亡的重要原因。传统上，病因是根据术后检测到的微生物推断出来的。然而，术中手术部位及其所携带的细菌却鲜有研究。与依赖培养的方法相比，基因组技术的发展提供了一种新的敏感工具，有助于对手术部位的细菌进行特征描述。这篇文献综述的目的是确定术中手术部位采样是否具有预测作用。我们进行了一项系统的文献综述，以识别相关文献，这些文献报道了对任何专科的术中手术部位进行采样的研究，采用传统培养或基于非培养的基因组测序技术，并尝试与感染进行相关性分析。该综述在MEDLINE、EMBASE和Cochrane数据库中检索了1959年至2021年的研究。初步检索到7835篇文章；筛选后剩下36篇。31篇文章关注依赖培养的技术，5篇关注非培养技术。亚组荟萃分析表明，术中培养阳性会带来下游感染风险，比值比为8.6，但受高假阳性率和无法将术中培养与术后感染相关联的限制。相比之下，通过基因组测序的非培养研究没有预测性，但表明手术切口是一个复杂的微生物群落，某些患者会出现向生态失调的转变。术中手术部位显然携带细菌。两种技术对细菌在手术部位感染中的作用给出了不同的解释。切口内可能存在更复杂的动态群落，使患者易受感染。在大规模研究中，包括对感染患者进行微生物群落特征分析，可能会提高我们预测和预防接受手术患者切口手术部位感染的能力。
