Lyutenski Stefan, Wendt Susanne, Lieder Anja, James Paul, Bloching Marc
Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland.
HNO. 2024 Jun;72(6):405-411. doi: 10.1007/s00106-024-01423-0. Epub 2024 Jan 27.
There is no consensus in the pertinent literature regarding the optimal antibiotic prophylaxis (AP) for cochlear implantation (CI). This study evaluates the implementation of standardized risk-based AP combined with application of an adhesive film dressing.
All CI cases since September 2019 were retrospectively reviewed for postoperative wound complications. While all patients received preoperative AP with ceftriaxone, postoperative AP after CI in patients older than 7 years was no longer routinely performed in our clinic. Exceptions were made according to predefined criteria for an increased risk of infection. The wound was covered with a transparent adhesive polyurethane film.
In 72% of the 219 cases, we did not perform postoperative AP. The overall wound complication rate was 2.7% (in the groups with and without postoperative AP, 4.9% and 1.9%, respectively). Wound infection did not occur in any of the patients without postoperative AP older than 70 years (n = 32), with controlled diabetes mellitus (n = 19), or with reimplantation due to technical defect (n = 19). The film did not need to be changed until the suture material was removed.
Standardized risk-based AP can avoid prolonged administration of antibiotics in selected patients. The film dressing permits continual examination and sufficient wound protection.
关于人工耳蜗植入（CI）的最佳抗生素预防（AP），相关文献尚无共识。本研究评估了基于风险的标准化AP联合应用贴膜敷料的实施情况。
回顾性分析2019年9月以来所有CI病例的术后伤口并发症。虽然所有患者术前均接受头孢曲松AP，但在我们诊所，7岁以上患者CI术后不再常规进行AP。根据预先定义的感染风险增加标准进行例外处理。伤口用透明粘性聚氨酯膜覆盖。
219例病例中，72%未进行术后AP。总体伤口并发症发生率为2.7%（术后进行AP和未进行AP的组分别为4.9%和1.9%）。70岁以上（n = 32）、糖尿病得到控制（n = 19）或因技术缺陷进行再次植入（n = 19）且未进行术后AP的患者均未发生伤口感染。在拆除缝线材料之前无需更换贴膜。
基于风险的标准化AP可避免在部分患者中长时间使用抗生素。贴膜敷料便于持续检查并能充分保护伤口。
