Division of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA.
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA.
Sci Transl Med. 2024 Apr 10;16(742):eadk8222. doi: 10.1126/scitranslmed.adk8222.
Despite modern antiseptic techniques, surgical site infection (SSI) remains a leading complication of surgery. However, the origins of SSI and the high rates of antimicrobial resistance observed in these infections are poorly understood. Using instrumented spine surgery as a model of clean (class I) skin incision, we prospectively sampled preoperative microbiomes and postoperative SSI isolates in a cohort of 204 patients. Combining multiple forms of genomic analysis, we correlated the identity, anatomic distribution, and antimicrobial resistance profiles of SSI pathogens with those of preoperative strains obtained from the patient skin microbiome. We found that 86% of SSIs, comprising a broad range of bacterial species, originated endogenously from preoperative strains, with no evidence of common source infection among a superset of 1610 patients. Most SSI isolates (59%) were resistant to the prophylactic antibiotic administered during surgery, and their resistance phenotypes correlated with the patient's preoperative resistome ( = 0.0002). These findings indicate the need for SSI prevention strategies tailored to the preoperative microbiome and resistome present in individual patients.
尽管采用了现代的抗菌技术，手术部位感染（SSI）仍然是手术的主要并发症。然而，SSI 的起源以及这些感染中观察到的高抗生素耐药率仍知之甚少。我们使用仪器化脊柱手术作为清洁（I 类）皮肤切口的模型，前瞻性地对 204 名患者的术前微生物组和术后 SSI 分离株进行了采样。结合多种形式的基因组分析，我们将 SSI 病原体的身份、解剖分布和抗生素耐药谱与从患者皮肤微生物组中获得的术前菌株进行了关联。我们发现，86%的 SSI 源自术前菌株的内源性，包含了广泛的细菌种类，在一个包含 1610 名患者的超集样本中没有共同来源感染的证据。大多数 SSI 分离株（59%）对手术期间使用的预防性抗生素有耐药性，其耐药表型与患者的术前耐药组（ = 0.0002）相关。这些发现表明，需要针对个体患者术前微生物组和耐药组制定特定的 SSI 预防策略。
