Emmerson M
Department of Microbiology, University Hospital, Queens Medical Center, Nottingham, UK.
New Horiz. 1998 May;6(2 Suppl):S3-10.
Why some patients develop postoperative surgical wound infection and others do not remains a mystery. There are many risk factors for infection, and mathematical scoring systems are often good predictors of infection; yet, some patients with a plethora of risk factors fail to develop surgical site infections. Even patients with established abdominal infection do not automatically develop wound infection. Early experimental work, now confirmed in the clinical setting, dictates that bacteria must be in the wound to cause infection; the minimal infecting dose will depend on the environmental conditions in the wound. The presence of foreign bodies, trauma, hematoma, etc., will enhance the effect of the inoculum; therefore, surgical debridement and careful surgery are necessary to reinforce the host defenses. Some bacteria, e.g., Staphylococcus aureus and Streptococcus pyogenes, have a greater propensity to cause infection, so extensive infection-control practices are necessary to prevent or contain these pathogens. To minimize the risk of surgical site infection, individual patient risk factors must be identified and modified whenever possible. The patient should be prepared for the operation and appropriate skin antiseptics should be used on the operative site. The patient should be considered for perioperative antibiotic prophylaxis and, if appropriate, bowel preparation should be carried out. Care and attention to the theater operating environment is important, especially for cases in which airborne transmission of bacteria should be controlled, e.g., ultraclean air systems for implant surgery. In elective surgery, the source of bacteria that cause infection is either the patient's normal flora (e.g., skin or bowel), i.e., endogenous, or the surgical staff or environment, i.e., exogenous. Surgical expertise and theater discipline are essential components in the fight against surgical sepsis.
为什么有些患者会发生术后手术伤口感染而其他患者却不会，这仍是个谜。感染存在许多风险因素，数学评分系统通常是感染的良好预测指标；然而，一些存在大量风险因素的患者却并未发生手术部位感染。甚至已经发生腹部感染的患者也不会自动出现伤口感染。早期的实验研究现已在临床环境中得到证实，表明细菌必须存在于伤口中才能导致感染；最小感染剂量将取决于伤口的环境条件。异物、创伤、血肿等的存在会增强接种物的作用；因此，手术清创和精细手术对于增强宿主防御能力是必要的。一些细菌，例如金黄色葡萄球菌和化脓性链球菌，具有更强的感染倾向，所以必须采取广泛的感染控制措施来预防或遏制这些病原体。为了将手术部位感染的风险降至最低，必须识别并尽可能改变个体患者的风险因素。患者应做好手术准备，手术部位应使用适当的皮肤消毒剂。应考虑对患者进行围手术期抗生素预防，并且在适当情况下应进行肠道准备。关注手术室的操作环境很重要，特别是对于需要控制细菌空气传播的病例，例如植入手术的超净空气系统。在择期手术中，导致感染的细菌来源要么是患者的正常菌群（例如皮肤或肠道），即内源性的，要么是手术人员或环境，即外源性的。手术专业技能和手术室规范是对抗手术败血症的重要组成部分。
