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[犬猫清洁和清洁-污染手术围手术期感染危险因素的前瞻性分析,特别参考围手术期和术后抗生素的使用]

[Prospective analysis of risk factors for perioperative infections in clean and clean-contaminated surgeries in dogs and cats with special reference to perioperative and postoperative antibiotic use].

作者信息

Degen M, Torgerson P, Nolff M C

机构信息

Klinik für Kleintierchirurgie der Universität Zürich.

Epidemiologie Vetsuisse, Tierspital, Universität Zürich.

出版信息

Schweiz Arch Tierheilkd. 2023 Apr;165(4):250-0. doi: 10.17236/sat00391.

Abstract

With every surgical procedure there is a risk of postoperative infection (surgical site infection = SSI). This risk of infection can be influenced by various factors, including perioperative antibiotic prophylaxis. In terms of antibiotic stewardship, antibiotics should only be used if there is a proven benefit for the patient. However, this advantage has not yet been conclusively proven, especially for clean and clean-contaminated surgeries. The aim of our study was to document various relevant influencing factors on the infection rate after clean and clean-contaminated surgeries in dogs and cats. In particular, it was documented to what extent a reduced use of antibiotics affects the infection rate in the context of all influencing factors. Over a period of eleven months, 807 clean and clean-contaminated surgeries in dogs and cats were prospectively analyzed with possible influencing factors (gender, ASA classification, underlying endocrinological diseases, duration of anesthesia, duration of surgery, type of surgery, perioperative antibiotic prophylaxis (POA), duration of hospitalization) affecting the infection rate. After surgery all cases were followed up either 30 or 90 days, if implants were used. The effect of the various factors was evaluated using multivariable logistic regression analysis. SSI was detected in 25/664 clean and 10/143 clean-contaminated surgeries. Longer hospitalization, without antimicrobial prophylaxis, and male animals had a significantly higher risk of SSI. In clean surgeries, SSI occurred in 2,3 % of all cases with POA and 5,3 % without POA. The SSI in clean-contaminated was 3,6 % with POA and 9 % without. This difference resulted mainly from the results of osteosynthesis, gastrointestinal and skin surgeries. However, other types of surgeries, such as castrations, neurological interventions, abdominal and thoracic surgeries, and surgeries in the head and neck region, showed comparable infection rates with and without POA.

摘要

每一次外科手术都存在术后感染(手术部位感染 = SSI)的风险。这种感染风险会受到多种因素的影响,包括围手术期抗生素预防。就抗生素管理而言,只有在对患者有明确益处时才应使用抗生素。然而,这一优势尚未得到确凿证明,尤其是对于清洁手术和清洁 - 污染手术。我们研究的目的是记录犬猫清洁手术和清洁 - 污染手术后感染率的各种相关影响因素。特别是,记录在所有影响因素的背景下减少抗生素使用对感染率的影响程度。在十一个月的时间里,对犬猫的807例清洁手术和清洁 - 污染手术进行了前瞻性分析,分析了可能影响感染率的因素(性别、美国麻醉医师协会(ASA)分级、潜在内分泌疾病、麻醉持续时间、手术持续时间、手术类型、围手术期抗生素预防(POA)、住院时间)。手术后,如果使用了植入物,所有病例均随访30天或90天。使用多变量逻辑回归分析评估各种因素的影响。在664例清洁手术中有25例检测到SSI,在143例清洁 - 污染手术中有10例检测到SSI。住院时间延长、未进行抗菌预防以及雄性动物发生SSI的风险显著更高。在清洁手术中,有POA的所有病例中SSI发生率为2.3%,无POA的为5.3%。清洁 - 污染手术中有POA的SSI发生率为3.6%,无POA的为9%。这种差异主要源于骨固定、胃肠道和皮肤手术的结果。然而,其他类型的手术,如去势手术、神经干预手术、腹部和胸部手术以及头颈部手术,有POA和无POA时的感染率相当。

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