Savio Lucie, Simeone Pierre, Baron Sophie, Antonini François, Bruder Nicolas, Boussen Salah, Zieleskiewicz Laurent, Blondel Benjamin, Prost Solène, Baucher Guillaume, Lebaron Marie, Florant Thibault, Boucekine Mohamed, Leone Marc, Velly Lionel
Département d'Anesthésie-Réanimation - Marseille, Université Aix-Marseille, CHU Timone, Marseille, France.
Département d'Anesthésie-Réanimation - Marseille, Université Aix-Marseille, CHU Nord, Marseille, France.
Ann Intensive Care. 2024 Sep 2;14(1):136. doi: 10.1186/s13613-024-01370-7.
Severe trauma is the leading cause of disability and mortality in the patients under 35 years of age. Surgical site infections (SSI) represent a significant complication in this patient population. However, they are often inadequately investigated, potentially impacting the quality of patient outcomes. The aim of this study was to investigate the epidemiology of SSI and risk factors in severe trauma patients.
We conducted a multicenter retrospective cohort study screening the severe trauma patients (STP) admitted to two intensive care units of an academic institution in Marseille between years2018 and 2019. Those who underwent orthopedic or spinal surgery within 5 days after admission were included and classified into two groups according to the occurrence of SSI (defined by the Centers for Disease Control (CDC) international diagnostic criteria) or not. Our secondary goal was to evaluate STP survival at 48 months, risk factors for SSI and microbiological features of SSI.
Forty-seven (23%) out of 207 STP developed an SSI. Mortality at 48-months did not differ between SSI and non-SSI patients (12.7% vs. 10.0%; p = 0.59). The fractures of 22 (47%) severe trauma patients with SSI were classified as Cauchoix 3 grade and 18 (38%) SSI were associated with the need for external fixators. Thirty (64%) severe trauma patients with SSI had polymicrobial infection, including 34 (72%) due to Gram-positive cocci. Empirical antibiotic therapy was effective in 31 (66%) cases. Multivariate analysis revealed that risk factors such as low hemoglobin, arterial oxygenation levels, hyperlactatemia, high serum creatinine and glycemia, and Cauchoix 3 grade on the day of surgery were associated with SSI in severe trauma patients. The generated predictive model showed a good prognosis performance with an AUC of 0.80 [0.73-0.88] and a high NPV of 95.9 [88.6-98.5] %.
Our study found a high rate of SSI in severe trauma patients, although SSI was not associated with 48-month mortality. Several modifiable risk factors for SSI may be effectively managed through enhanced perioperative monitoring and the implementation of a patient blood management strategy.
严重创伤是35岁以下患者致残和死亡的主要原因。手术部位感染（SSI）是该患者群体中的一种重要并发症。然而，对其调查往往不够充分，这可能会影响患者的治疗效果。本研究旨在调查严重创伤患者手术部位感染的流行病学情况及危险因素。
我们进行了一项多中心回顾性队列研究，筛查了2018年至2019年间入住马赛一家学术机构两个重症监护病房的严重创伤患者（STP）。纳入入院后5天内接受骨科或脊柱手术的患者，并根据是否发生手术部位感染（根据疾病控制中心（CDC）国际诊断标准定义）将其分为两组。我们的次要目标是评估严重创伤患者48个月时的生存率、手术部位感染的危险因素以及手术部位感染的微生物学特征。
207例严重创伤患者中有47例（23%）发生了手术部位感染。手术部位感染患者和未发生手术部位感染患者48个月时的死亡率无差异（12.7%对10.0%；p = 0.59）。22例（47%）发生手术部位感染的严重创伤患者骨折被分类为Cauchoix 3级，18例（38%）手术部位感染与需要外固定架有关。30例（64%）发生手术部位感染的严重创伤患者有多种微生物感染，其中34例（72%）为革兰氏阳性球菌感染。经验性抗生素治疗在31例（66%）病例中有效。多变量分析显示，低血红蛋白、动脉氧合水平、高乳酸血症、高血清肌酐和血糖以及手术当天Cauchoix 3级等危险因素与严重创伤患者的手术部位感染有关。生成的预测模型显示出良好的预后性能，AUC为0.80[0.73 - 0.88]，阴性预测值高，为95.9[88.6 - 98.5]%。
我们的研究发现严重创伤患者手术部位感染率较高，尽管手术部位感染与48个月死亡率无关。通过加强围手术期监测和实施患者血液管理策略，可以有效管理手术部位感染的几个可改变危险因素。
