术后切口感染危险因素的病例对照研究

本研究对某医院１９９２年７月～１９９３年９月期间住院的外科病人术后切口感染及其危险因素进行了前瞻性监测研究，共监测外科住院病人４２９８例，其中１５３例手术病人发生术后切口感染，２６３５例手术病人未发生任何部位的医院感染。应用成组的病例对照研究方法，通过单因素分析，发现切口分类、术前预防应用抗生素、暴露于ＩＣＵ、导尿、动、静脉插管、术中使用呼吸机、手术时间、引流和术后切口感染有显著的联系。Ｌｏｇｉｓｔｉｃ回归分析筛选出了５个互相独立的与术后切口感染有显著联系的因素，它们是术前预防应用抗生素、引流切口分类、手术时间≥２小时、暴露于ＩＣＵ，但术前预防应用抗生素与术后切口、感染呈负相关。     

预防使用抗生素与切口感染的调查

本文总结了我院普外１９９２年１月～１９９３年１２月，１３８１例手术患者术后常规预防使用抗生素和时间性预防使用抗生素与切口感染情况。术后常规预防使用抗生素７４６例，发生医院感染１０４例，感染率１３．９％，其中切口感染８３例，占感染总数７９．８％。时间性预防使用抗生素６６５例，发生医院感染５７例，感染率８．９％。其中切口感染２０例，占感染总数３５．１％。二者比较，Ｐ＜０．０５。     

胃癌术后切口感染相关因素分析

目的 了解胃癌术后切口感染相关因素,探讨预防手术切口感染的对策.方法 对2008年6月-2010年12月胃癌手术后280例患者发生切口感染的相关因素进行回顾性分析.结果 280例胃癌术后患者中,切口感染30例,感染率为10.71％;感染者平均住院时间为(30.0±4.2)d,未感染者(18.0±3.8)d,差异有统计学意义(P＜0.01);不同手术方式患者的切口感染率差异有统计学意义(P＜0.01),其中全胃切除手术感染率为20.00％,胃大部切除手术的感染率为5.29％;年龄＞65岁、肥胖、营养差、手术使用电刀、围手术期未应用抗菌药物者切口感染率高(P＜0.05),术前吸烟、由助手缝合者切口感染率高(P＜0.01).结论 改善患者营养、术前预防抗菌治疗、术后避免剧烈咳嗽、关腹前切口清创、提高手术医师的水平、尽量避免开腹时使用电刀等措施能有效预防切口感染.     

会阴侧切缝合术后护理

目的预防会阴侧切口术后的感染，降低感染率。方法侧切口表面用消毒药，局部照射，口服抗生素。结果感染率降低，感少产妇的痛苦。结论会阴佣切口术后预防性用抗生素，能更好预防切口的惑染或愈合不好。     

101例普外科手术切口感染调查及分析

目的：了解普外科切口感染原因，以便采取有效措施降低切口感染率。方法：采用回顾性调查两年外科切口感染状况。结果：普外科切口感染率6．94％，占全院切口感染的57．45％，其中Ⅰ类手术感染率1．18％，Ⅱ类手术感染率9．08％，Ⅲ类手术感染率14．05％；感染切口分泌物培养病原菌以G^-需氧杆菌为主。结论：普外科切口感染危险因素很多，主要与手术种类、手术方式、年龄、住院时间、抗生素使用明显相关。     

腹腔镜胆囊切除术后脐孔切口感染的分析

目的：探讨腹腔镜胆囊切除术后脐孔感染的相关因素，方法：回顾性分析2001年收治的胆囊切除术患者脐孔切口合情况，结果：211例患者中感染11例，脐孔感染率5．47％，结论：脐孔切口感染与术前脐孔红肿、术中缝合方式及术后用碘伏消毒明显相关，提出术前准确脐孔时动作应轻柔，术中采用常规缝合方式，术后对脐孔切口常规用碘伏进行换药消毒。     

老年胃癌患者手术切口感染因素分析

目的：探讨老年胃癌患者切口感染的危险因素。方法：对笔者所在医院收治的96例老年胃癌患者的手术方式以及身体指标等与切口感染的相关性进行分析。结果：Billroth Ⅰ式胃切除术感染率为6．25％（3／48），BillrothⅡ式胃切除术感染率为15．63％（5／32），根治性全胃切除术感染率为31．25％（5／16），比较差异具有统计学意义（P〈0．05）。影响术后切口感染的因素，经统计高龄患者、肥胖、营养差、吸烟饮酒、术后剧烈咳嗽、有基础性病变、未运用抗生素的患者切口感染率高。结论：高龄、肥胖、营养差、吸烟饮酒、术后剧烈咳嗽、有基础性病变、未运用抗生素等均是导致胃癌患者术后感染的危险因素。     

肾移植术后感染的临床分析

目的 为肾移植术后预防感染提供参考。方法 对我院7年例肾移植术后发生14例次感染的临床资料进行分析。结果 感染率26．4％，病死率14．2％，主要致病因素为细菌、真菌、病毒，主要感染部位为肺脏、泌尿道。结论 必须从受体选择、免疫抑制药以及抗生素合理使用等方面预防感染。     

腹股沟疝无张力修补术是否应用抗生素的对比研究

目的探讨腹股沟疝无张力修补术是否需要常规预防性应用抗生素。方法选择204例成年人腹股沟疝患者,根据入院先后顺序按1：3比例随机分为治疗组（51例）和对照组（153例）,治疗组术前使用第一代头孢菌素1次;对照组术前、术后均不使用抗生素,对比两组术后早期切口感染发生情况。结果204例腹股沟疝患者中5例发生术后切口感染,其中治疗组1例,感染率2．0％（1／51）,对照组4例,感染率2．6％（4／153）,两组比较差异无统计学意义（r=0．000,P=1．000）。两组术后第3天白细胞计数、嗜中性粒细胞百分比及住院时间、住院费用比较差异无统计学意义（P〉0．05）。结论无高危因素的成年人腹股沟疝无张力修补术常规应用抗生素预防术后切口感染无实质性必要。     

头孢西丁预防肛肠外科患者术后切口感染的效果研究

目的观察头孢西丁预防肛肠外科手术患者术后切口感染的效果,以降低肛肠外科手术患者切口感染率。方法选择2016年1月-2017年1月医院收治的120例肛肠外科手术患者为研究对象,采用数字随机表法分为对照组和试验组,每组60例;对照组按照肛肠外科手术临床路径于围术期采取相应措施预防术后切口感染,试验组在对照组预防切口措施基础上,再于术前、术后给予头孢西丁预防术后切口感染,分析比较两组术后一个月切口愈合、感染率、药物不良反应、术后住院时间等情况。结果术后1个月,试验组发生术后感染1例,感染率1.67%,对照组发生术后感染4例,感染率6.67%,试验组感染率低于对照组(P<0.05);试验组术后住院时间低于对照组(P<0.05);对照组大肠埃希菌构成比高于试验组(P<0.05)。结论头孢西丁能有效预防肛肠外科患者术后切口感染,且不增加患者药物不良反应率,缩短患者术后住院时间,对肛肠手术患者具有一定的临床价值。     

恶性骨肿瘤切除骨关节重建术后感染分析

目的控制骨肿瘤切除骨关节重建术的感染。方法对１１０例四肢恶性骨肿瘤切除骨关节重建术后感染的可能因素进行了分析。结果发现６种术式术后感染率为１１．８％，其中液氮灭活瘤段再植术后感染率最高，达２６％，第二高发者为同种异体骨关节置换术，为１１．１％，其感染主要表现为慢性感染。结论肢体抢救术式、患者免疫功能状态、抗生素的合理预防应用、排异反应及高质量的护理与术后感染的发生密切相关。     

Preoperative low molecular weight heparin as venous thromboembolism prophylaxis in patients at risk for prosthetic infection after knee arthroplasty.

OBJECTIVE: To investigate the effect of preoperative initiation of low molecular weight heparin as prophylaxis for deep venous thrombosis in patients at risk of developing surgical-site infections after knee arthroplasty. DESIGN: Case-control study nested in a cohort. The incidence of surgical-site infection in the cohort was calculated. With the use of data extracted from medical histories and after adjustment for other risk factors, the effect of preoperative heparinization on the risk of incisional and prosthetic infection among case-patients and control-patients (1:3 ratio) was assessed. SETTING: Orthopedic department in a tertiary-care referral hospital. PATIENTS: A cohort of 160 consecutive patients who had received prosthetic knee implants between October 1, 2001, and November 30, 2003. RESULTS: Eighteen patients with surgical-site infections were identified, yielding an incidence of incisional and prosthetic infection of 6.9 (95% confidence interval [CI95], 3.5 to 12.0) and 4.4 (CI95, 1.8 to 8.8) cases per 100 patients undergoing surgery, respectively. Surgical-site infection was associated with preoperative use of low molecular weight heparin (odds ratio [OR], 6.2 after adjustment for medical and surgical factors; CI95 1.5 to 23). Prosthetic infection was strongly associated with preoperative use of prophylaxis (OR, undetermined [100% exposure in case-patients vs 35% exposure in control-patients]; P = .002), but incisional surgical-site infection was not. CONCLUSION: The use of low molecular weight heparins immediately before knee arthroplasty as prophylaxis for deep venous thrombosis should be questioned because of probable increased risk of prosthetic infection.     

Postoperative wound infection: Relation to different types of operation and wound contamination categories in orthopaedic surgery

During one year, 1,407 operations were performed on inpatients in an orthopaedic department. The presence or absence of postoperative wound infection was recorded during the hospital stay, at discharge and at follow up. Wound infections were linked to operations of different contamination categories and to the different types of operation performed. Better information about the risk for postoperative wound infection and the need for antibiotic prophylaxis was provided by considering the different operation types.     

探讨快通道外科技术在综合外科围手术期中的应用

目的：探讨快通道外科技术在综合外科围手术期中应用的护理效果。方法：将192例患者分为对照组和观察组两组,对照组96例手术患者按常规护理;观察组96例手术患者应用快通道外科技术进行术前积极的心理护理、详细的健康教育和有效的交流,适当补充场内营养,不常规灌肠、不常规留置胃管尿管,缩短禁食、禁饮时间;术中严格控制输液量及盐水入量、充足吸氧、预防性应用抗生素、选择较好的手术方式最佳的麻醉方法及切口模式、合理调节室温并有效保暖、不常规放置腹部引流管;术后联合镇痛、早期肠内营养、尽早拔除腹部引流管尿管、早期功能锻炼和下床活动。结果：观察组96例手术患者在病情知晓率、护理配合程度、满意度调查方面较对照组明显提高,术后肛门排气排便时间较对照组提前,没有出现恶心呕吐、发热、误吸、肺部感染、静脉栓塞、切口感染等并发症,只有1例吻合口瘘,大大缩短了住院时间、降低了医疗费用。结论：应用快通道外科技术对手术患者进行围手术期护理,能更合理有效地控制患者的病理生理变化,减少了机体对手术所产生的应激和炎症反应,明显减少了并发症,加快了术后康复的速度,减轻了社会、医院及患者家庭的经济负担,值得推广。     

Incidence, risk factors and outcome of infection in a 1-year hysterectomy cohort: a prospective follow-up study

A prospective study was performed following 687 patients who underwent abdominal, vaginal and laparoscopic hysterectomy for benign conditions in Turku University Hospital. This study evaluates and compares infection after hysterectomy and determines risk factors associated with postoperative infection. Infective episodes were recorded during hospital stay, convalescence for 4 to 6 weeks at home and for 1 year of follow-up. Factors found to be statistically significant for hospital-acquired infection on univariate analysis were subsequently assessed by means of multivariate analysis. During the hospital stay 23.7% of the study population became infected, 38.1% after vaginal hysterectomy, 23.4% after abdominal hysterectomy and 3.0% after laparoscopic hysterectomy. Over half of all hospital-acquired infections were lower urinary tract infections. Infection during convalescence occurred in 19.2% of patients: 29.5% in the vaginal hysterectomy group, 17.4% in the abdominal hysterectomy group and 16.7% in the laparoscopic hysterectomy group. One year of follow-up did not find any infection directly attributable to surgery. Five factors were found to be related to in-hospital infection on multivariate analysis. These were lack of antibiotic prophylaxis, blood loss during operation, intermittent catheterization, anaemia and medication for urinary or bowel dysfunction after operation.     

Surgical antibiotic prophylaxis: effect in postoperative infections

Objective: to assess the risk of surgical wound infection and hospital acquired infections among patients with and without adequate antibiotic prophylaxis. Also, to provide models to predict the contributing factors of hospital infection and surgical wound infection. Design: survey study. Prospective cohort study over 14 months, with data collected by a nurse and a epidemiologist through visits to the surgical areas, a review of the medical record and consultation with the medical doctor and nurses attending the patients. Setting: Two hundred and fifty bed, general hospital serving Puertollano (Ciudad Real), population – 50,000. Results: between February 1998 and April 1999, 754 patients underwent surgery, 263 (34.88%) received appropriate peri-operative prophylaxis while 491 (65.12%) received inadequate prophylaxis. For those who received adequate antibiotic prophylaxis, the percentage of nosocomial infection was 10.65% compared with the group who received inadequate prophylaxis in which the percentage of nosocomial infection was 33.40%. The relative risk of nosocomial infection was, therefore, 4.21 times higher in the latter group (confidence intervals 95%: 2.71–6.51). A patient in the inadequate prophylaxis group had a 14.87% chance of wound infection while a patient in the adequate prophylaxis group had a 4.56% chance of wound infection. The relative risk of wound infection was 3.65 times higher in the group that received inadequate prophylaxis (confidence intervals 95%: 1.95–6.86). The final regression logistic model to assess nosocomial infection incorporated seven prognostic factors: age, length of venous periferic route, vesicle catheter, duration of operation, obesity, metabolic or neoplasm diseases and adequate or inadequate prophylaxis. When we incorporated these variables in the multi-factorial analysis we found that the relative risk of developing nosocomial infection was 2.33 times higher in the group which received inadequate prophylaxis. When we applied the second logistic multiple regression model (wound infection), we discovered that the probability of developing surgical wound infection was 2.32 times higher in the group which received inadequate prophylaxis as opposed to the group, which received adequate prophylaxis. The goodness of fit (Hosmer–Lemeshow test) showed a correct significance in all models. Conclusions: a multi-factorial analysis was applied to identify the high-risk patients and the risk factors for postoperative infections. Through the application of these multiple regression logistic models, we conclude that the correct antibiotic prophylaxis is effective and will subsequently reduce postoperative infection rates, especially in high-risk patients. Therefore, the choice of antimicrobial agent should be made on the basis of the criteria of hospital committee.     

Antibiotic prophylaxis and the risk of Clostridium difficile-associated diarrhoea.

To test the hypothesis that extended antibiotic prophylaxis increases the risk of Clostridium difficile -associated diarrhoea (CDAD), we conducted a retrospective cohort study of 2641 patients under-going cardiovascular surgery. Main outcome measures were the duration of prophylaxis (< 48 h vs. > 48 h) and the occurrence of CDAD. CDAD occurred in 31 patients (1.2%), who were significantly older (70 +/- 9 y vs. 66 +/- 10 y; P = 0.03), received more therapeutic antibiotics (2.2 +/- 1.9 vs. 0.4 +/- 0.9; P = 0.001) and had a longer postoperative hospital stay (26 +/- 19 d vs. 9 +/- 8 d; P < 0.001) than non-cases. After adjusting for confounding, we did not observe an association between prolonged prophylaxis and CDAD [adjusted odds ratio (AOR), 0.8; CI, 0.4-1.8]. In contrast, three independent predictors were identified: increasing length of hospital stay (AOR per one-day-increment, 1.03; CI, 1.01-1.05), and treatment with third generation cephalosporins (AOR, 5.9; CI, 2.2-16.0) or beta-lactam-beta-lactamase inhibitor combinations (AOR, 4.6; CI, 1.7-12.3). Our results did not confirm that extended prophylaxis after clean surgery increases the risk of CDAD, which remains an uncommon postoperative complication, associated even with short antibiotic exposure.     

Nosocomial infections and misuse of antibiotics in a provincial community hospital, Saudi Arabia

The incidence of nosocomial infection and prevalence of antibiotic misuse were studied in a 174-bed community hospital in Saudi Arabia over a six-month period. Of 2445 patients admitted, 8.5% developed nosocomial infection, the rates were highest for nursery (35.8%), intensive care (19.8%), gynaecological (16.2%) and surgical (11.7%) patients. Urinary tract (31.3%), wound (27.1%) and blood (14.9%) infections accounted for more than 70% of the infections. Staphylococcus aureus (23%) and Pseudomonas aeruginosa (11%), caused more than 90% of the infections. The majority of the bacterial pathogens (79%) were multi-drug resistant. Over 80% of patients were administered prophylactic and/or therapeutic antibiotics, with 53% receiving multiple antibiotics; 72% of the antibiotics were judged to be misused. Both prophylaxis and treatment were mostly misguided and clinically unwarranted. Host- and hospital-associated infection risk factors were identified. The minimum government cost estimates for the nosocomial infections and misused antibiotics were US $273 180 and $565 603, respectively. The findings emphasize the need for effective measures to reduce both the high infection rates and widespread antibiotic misusage in the hospital. Such measures should include institution of an effective infection control committee and a hospital antibiotic policy.     

Infected urine as a risk factor for postprostatectomy wound infection

OBJECTIVE: To study the relation of preoperative infected urine and postprostatectomy wound infection in patients with and without indwelling bladder catheters. DESIGN: Patients undergoing prostatectomy were evaluated for the presence of infected urine prior to prostatectomy and postoperative wound infection. They were further divided into patients with indwelling urinary catheter and catheter-free patients. All had received antibiotic prophylaxis. PATIENTS: One hundred fifty consecutive patients undergoing open prostatectomy--mean age was 67 years; 100 patients with an indwelling catheter for a mean period of 50 days; 50 catheter-free patients. RESULTS: Wound infection was found in 19 of 81 (23.5%) and in 6 of 69 (8.7%) patients with infected and sterile urine, respectively (p = .028). In patients with indwelling catheters prior to operation, wound infection was 22.4% when urine was infected and 8.3% when it was not. In patients without catheters, infected urine was associated with 40% of wound infections, as compared with 8.9% of wound infections in patients with sterile urine. Organisms obtained from infected wound and urine were identical in 84% of cases. These results were obtained despite antibiotic prophylaxis. CONCLUSIONS: Wound infection has been demonstrated to be a postprostatectomy complication directly related to the presence of urinary infection at surgery; thus, elective prostatectomy should be deferred until urine becomes sterile.     

围术期合理使用抗菌药物新模式探讨

目的评估手术室抗菌药物基数库的建立对围手术期预防性用药的合理性及手术切口感染情况的影响。方法前瞻性调查3794例病例围手术期抗菌药物应用情况,并对基数库建立前后抗菌药物应用的合理性进行比较。结果抗菌药物基数库建立后,围术期抗菌药物正确使用率明显提高,由1.52%上升至20.89%;手术切口感染率也有下降趋势,心外科手术切口感染率由1.79%下降至0.27%。结论手术室建立抗菌药物基数库有利于提高围术期抗菌药物使用的规范性,值得推广。