Stephan R N, Munschauer C E, Kumar M S
Department of Surgery, State University of New York at Buffalo, USA.
Arch Surg. 1997 Dec;132(12):1315-8; discussion 1318-9. doi: 10.1001/archsurg.1997.01430360061011.
The incidence of surgical wound infection in the presence of immunosuppression has been reported in the literature to approach 7%. Perioperative systemic antibiotic therapy is routinely used to reduce the occurrence of wound infections. This therapy is not without complications, including adverse effects and development of resistant strains.
Surgical wound infection rates during the first 100 days after renal transplantation were studied in 102 consecutive patients. Eighty-one patients underwent cadaveric transplantation and 21 patients underwent living-related donor transplantation from February 1, 1991, to January 1, 1992. No systemic perioperative antibiotic coverage was used, but local antibiotic irrigation was part of the perioperative protocol.
Hahnemann University Hospital, Philadelphia, Pa, is a large, tertiary care center. Patients were initially hospitalized and were discharged during the 100-day follow-up period based on clinical status and improvement in renal function.
Twenty-seven (25%) of 102 patients had diabetes mellitus.
Induction immunosuppression consisted of azathioprine, prednisone, and anitlymphocyte globulin, while maintenance immunosuppression consisted of azathioprine, prednisone, and cyclosporine. Acute allograft rejection episodes were treated with steroids and/or OKT3 (Ortho Pharmaceutical Group, Raritan, NJ).
Two surgical wound infections (2%) occurred. In both, infection was superficial, resolving with wound drainage and intravenous antibiotics. The surgical wound infection rate was not significantly affected by age, sex, allograft source, or presence of diabetes mellitus.
Despite immunosuppression, the incidence of surgical wound infection was minimal, comparing favorably to rates reported for renal transplantation with the use of systemic antibiotics. Possible explanations for the low incidence of surgical wound infections include local wound irrigation, meticulous hemostasis, improved organ procurement techniques, and continuity in perioperative care.
文献报道免疫抑制情况下手术伤口感染的发生率接近7%。围手术期全身使用抗生素治疗通常用于降低伤口感染的发生率。这种治疗并非没有并发症，包括不良反应和耐药菌株的产生。
对102例连续的肾移植患者术后100天内的手术伤口感染率进行了研究。1991年2月1日至1992年1月1日期间，81例患者接受了尸体肾移植，21例患者接受了亲属活体供肾移植。围手术期未使用全身抗生素，但局部抗生素冲洗是围手术期方案的一部分。
宾夕法尼亚州费城的哈内曼大学医院是一家大型三级护理中心。患者最初住院，并在100天的随访期内根据临床状况和肾功能改善情况出院。
102例患者中有27例（25%）患有糖尿病。
诱导免疫抑制包括硫唑嘌呤、泼尼松和抗淋巴细胞球蛋白，维持免疫抑制包括硫唑嘌呤、泼尼松和环孢素。急性移植排斥反应发作采用类固醇和/或OKT3（奥索制药集团，拉里坦，新泽西州）治疗。
发生了2例手术伤口感染（2%）。两例感染均为表浅感染，通过伤口引流和静脉使用抗生素得以解决。手术伤口感染率不受年龄、性别、移植肾来源或糖尿病的影响。
尽管存在免疫抑制，但手术伤口感染的发生率很低，与使用全身抗生素的肾移植报道发生率相比更有利。手术伤口感染发生率低的可能原因包括局部伤口冲洗、细致的止血、改进的器官获取技术以及围手术期护理的连续性。
