Bertin M L, Crowe J, Gordon S M
Infection Control and Epidemiology, Cleveland Clinic Foundation, OH 44195, USA.
Am J Infect Control. 1998 Feb;26(1):61-5. doi: 10.1016/s0196-6553(98)70062-8.
Surgical site infection (SSI) after breast procedures may result in significant morbidity, psychologic trauma, and additional cost, SSI rates in patients at the Cleveland Clinic Foundation having biopsy, partial mastectomy, or modified radical mastectomy were higher during April and May 1995 than during the previous 12 months (8 infections for 74 procedures [10.8%] vs 10 for 378 [2.6%]; p < 0.006). Since 1993 one surgeon has performed most of these procedures, with no change in operative technique, skin preparation, or surgical team. A case-control study was performed to identify risk factors for infection.
A case patient was defined as any patient having a breast procedure from April 1994 through May 1995 with culture of a pathogen from surgical site drainage or aspiration or with erythema or presence of cellulitis treated by incision and drainage and/or antibiotic therapy. Randomly selected control patients were matched by time and procedure. There were 18 case patients and 37 control patients.
Factors associated with SSI were obesity (78% of cases vs 40% of controls; p = 0.02) and older age (mean 66 years in cases vs 56 years in controls; p = 0.005). After introduction of cefazolin sodium prophylaxis, SSI rate was reduced to 0.9% (3 infections for 332 procedures).
Host factors may contribute to SSI in breast procedures. Cefazolin sodium prophylaxis was useful in preventing SSI after breast surgery.
乳房手术后手术部位感染（SSI）可能导致严重的发病率、心理创伤和额外费用。1995年4月和5月，克利夫兰诊所基金会接受活检、乳房部分切除术或改良根治性乳房切除术的患者的SSI发生率高于前12个月（74例手术中有8例感染[10.8%]，而378例中有10例[2.6%]；p<0.006）。自1993年以来，大部分此类手术由一名外科医生进行，手术技术、皮肤准备或手术团队均无变化。进行了一项病例对照研究以确定感染的危险因素。
病例患者定义为1994年4月至1995年5月期间接受乳房手术，手术部位引流液或穿刺液培养出病原体，或有红斑或蜂窝织炎并接受切开引流和/或抗生素治疗的任何患者。随机选择的对照患者按时间和手术进行匹配。有18例病例患者和37例对照患者。
与SSI相关的因素是肥胖（病例组78%，对照组40%；p = 0.02）和年龄较大（病例组平均66岁，对照组平均56岁；p = 0.005）。引入头孢唑林钠预防措施后，SSI发生率降至0.9%（332例手术中有3例感染）。
宿主因素可能导致乳房手术中的SSI。头孢唑林钠预防措施对预防乳房手术后的SSI有效。
