Department of Emergency and Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China.
Medical Center of Soochow University, Suzhou, Jiangsu, China.
PLoS One. 2024 Apr 1;19(4):e0301353. doi: 10.1371/journal.pone.0301353. eCollection 2024.
Even though replantation of limb mutilation is increasing, postoperative wound infection can result in increasing the financial and psychological burden of patients. Here, we sought to explore the distribution of pathogens and identify risk factors for postoperative wound infection to help early identification and managements of high-risk patients.
Adult inpatients with severed traumatic major limb mutilation who underwent replantation from Suzhou Ruixing Medical Group between November 09, 2014, and September 6, 2022 were included in this retrospective study. Demographic, and clinical characteristics, treatments, and outcomes were collected. Data were used to analyze risk factors for postoperative wound infection.
Among the 249 patients, 185 (74.3%) were males, the median age was 47.0 years old. Postoperative wound infection in 74 (29.7%) patients, of whom 51 (20.5%) had infection with multi-drug resistant bacteria. Ischemia time (OR 1.31, 95% CI 1.13-1.53, P = 0.001), wound contamination (OR 6.01, 95% CI 2.38-15.19, P <0.001), and stress hyperglycemia (OR 23.37, 95% CI 2.30-236.93, P = 0.008) were independent risk factors, while the albumin level after surgery (OR 0.94, 95% CI 0.89-0.99, P = 0.031) was significant associated with the decrease of postoperative wound infection. Ischemia time (OR 1.21, 95% CI 1.05-1.40, P = 0.010), wound contamination (OR 8.63, 95% CI 2.91-25.57, P <0.001), and MESS (OR 1.32, 95% CI 1.02-1.71, P = 0.037 were independent risk factors for multi-drug resistant bacteria infection.
Post-replantation wound infection was common in patients with severe traumatic major limb mutilation, and most were multi-drug resistant bacteria. Ischemia time and wound contamination were associated with the increase of postoperative wound infection, including caused by multi-drug resistant. Positive correction of hypoproteinemia and control of stress hyperglycemia may be beneficial.
尽管肢体残缺再植的数量在不断增加，但术后伤口感染会增加患者的经济和心理负担。在这里，我们试图探讨病原体的分布，并确定术后伤口感染的危险因素，以帮助早期识别和管理高危患者。
回顾性分析 2014 年 11 月 09 日至 2022 年 9 月 6 日期间在苏州瑞兴医疗集团接受严重创伤性大肢体残缺再植的成年住院患者。收集人口统计学和临床特征、治疗和结局等数据。数据分析用于分析术后伤口感染的危险因素。
在 249 名患者中，185 名（74.3%）为男性，中位年龄为 47.0 岁。74 名（29.7%）患者发生术后伤口感染，其中 51 名（20.5%）感染了多重耐药菌。缺血时间（OR 1.31，95%CI 1.13-1.53，P=0.001）、伤口污染（OR 6.01，95%CI 2.38-15.19，P<0.001）和应激性高血糖（OR 23.37，95%CI 2.30-236.93，P=0.008）是独立的危险因素，而术后白蛋白水平（OR 0.94，95%CI 0.89-0.99，P=0.031）与术后伤口感染减少显著相关。缺血时间（OR 1.21，95%CI 1.05-1.40，P=0.010）、伤口污染（OR 8.63，95%CI 2.91-25.57，P<0.001）和 MESS（OR 1.32，95%CI 1.02-1.71，P=0.037）是多重耐药菌感染的独立危险因素。
严重创伤性大肢体残缺再植患者术后伤口感染常见，且多为多重耐药菌。缺血时间和伤口污染与术后伤口感染增加有关，包括多重耐药菌感染。积极纠正低蛋白血症和控制应激性高血糖可能有益。
