Hamudu Haitham, Nyawale Helmut, Silago Vitus, Mirambo Mariam M, Chalya Phillipo L, Mshana Stephen E
Department of Surgery, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Department of Surgery, Bugando Medical Centre, Mwanza, Tanzania.
J Orthop Surg Res. 2025 Mar 7;20(1):252. doi: 10.1186/s13018-025-05638-x.
Surgical site infections (SSIs) after limb amputations have been associated with increased patient morbidity, mortality and costs. This study aimed to determine the incidence, bacteriological profile and predictors of SSIs following limb amputation at Bugando Medical Centre (BMC) and Sekou Toure Regional Referral Hospital (SRRH).
The longitudinal study was conducted among patients undergoing limb amputations between March and July 2024 at BMC and SRRH. Pre-tested structured questionnaires were used to collect sociodemographic and clinical data. Clinical diagnosis of SSI was done using CDC criteria followed by collection of wound or pus swab for culture and susceptibility testing. Univariate and multivariate logistic regression modelling was done using STATA version 15.0 to assess associations between clinical variables and odds of SSI.
A total of 120 patients with a median (IQR) age of 58 [43.5-66.5] years were enrolled. The indications for limb amputations included diabetic foot ulcers (50.8%,61/120), trauma (8.3%,10/120), malignancy (8.3%,10/120), gangrene (9.2%,11/120), peripheral vascular disease (16.7%,20/120) and congenital malformations (6.7%,8/120). The incidence of SSIs was (30%,36/120), with Escherichia coli (36.7%; 11/30) and Staphylococcus aureus (23%; 7/30) being the most frequently isolated pathogens. More than half of the Gram-negative isolates were resistant to third and fourth generations cephalosporins which were commonly used as prophylactic antibiotics in the study settings. Age above 65 years (OR = 0.21, 95% CI: 0.05-0.95, p = 0.043), smoking (OR = 14.3, 95% CI: 1.33-10.00, p = 0.027), ASA Class III (OR = 13.33, 95% CI: 2.82-63.14, p = 0.001), longer surgery duration (≥ 2 h) (OR = 4.09, 95% CI: 1.30-12.89, p = 0.016) and blood transfusion (OR = 2.4, 95% CI: 0.7-8.00, p = 0.02) were independently associated with SSIs.
About one third of the patients developed SSIs following limb amputation. Odds of SSIs were increased in patients with low age, smoking, high ASA score, prolonged surgery and who received blood transfusion. This highlighted the need to update the management protocol of limb amputation in relation to antibiotics prophylaxis among patients with increased risk of SSIs based on the local antimicrobial surveillance prevalence data.
肢体截肢术后手术部位感染（SSIs）与患者发病率、死亡率及费用增加相关。本研究旨在确定布甘多医疗中心（BMC）和塞古·杜尔地区转诊医院（SRRH）肢体截肢术后SSIs的发生率、细菌学特征及预测因素。
在2024年3月至7月期间，对在BMC和SRRH接受肢体截肢手术的患者进行了纵向研究。使用预先测试的结构化问卷收集社会人口统计学和临床数据。采用美国疾病控制与预防中心（CDC）标准进行SSI的临床诊断，随后采集伤口或脓液拭子进行培养和药敏试验。使用STATA 15.0软件进行单因素和多因素逻辑回归建模，以评估临床变量与SSI发生几率之间的关联。
共纳入120例患者，年龄中位数（四分位间距）为58[43.5 - 66.5]岁。肢体截肢的指征包括糖尿病足溃疡（50.8%，61/120）、创伤（8.3%，10/120）、恶性肿瘤（8.3%，10/120）、坏疽（9.2%，11/120）、周围血管疾病（16.7%，20/120）和先天性畸形（6.7%，8/120）。SSIs的发生率为（30%，36/120），其中大肠埃希菌（36.7%；11/30）和金黄色葡萄球菌（23%；7/30）是最常分离出的病原体。超过一半的革兰阴性菌分离株对第三代和第四代头孢菌素耐药，而这两种药物在本研究环境中常用作预防性抗生素。65岁以上（比值比[OR]=0.21，95%置信区间[CI]：0.05 - 0.95，p = 0.043）、吸烟（OR = 14.3，95% CI：1.33 - 10.00，p = 0.027）、美国麻醉医师协会（ASA）分级III级（OR = 13.33，95% CI：2.82 - 63.14，p = 0.001）、手术时间较长（≥2小时）（OR = 4.09，95% CI：1.30 - 12.89，p = 0.016）和输血（OR = 2.4，95% CI：0.7 - 8.00，p = 0.02）与SSIs独立相关。
约三分之一的患者在肢体截肢后发生了SSIs。年龄较小、吸烟、ASA评分高、手术时间延长及接受输血的患者发生SSIs的几率增加。这突出表明需要根据当地抗菌药物监测流行数据，更新肢体截肢管理方案中针对SSIs风险增加患者的抗生素预防措施。
