胆石症手术切口感染与胆汁内细菌的关系

目的 :探讨胆石症手术切口感染与胆汁内细菌的关系。方法 :收集 4 2 0例胆石症手术患者的资料 ,全部行术中胆汁需氧培养及 12例手术后伤口感染患者的伤口分泌物培养。结果 :胆石症手术切口感染的细菌种类与胆汁内细菌感染一致有 9例 ,占 75 %。胆汁培养阳性 ,年龄 >6 0岁及胆总管结石患者的术后伤口感染较胆汁培养阴性、年龄 <6 0岁及单纯胆囊结石患者高。结论 :胆石症患者手术切口感染与病种、严重程度、年龄及胆汁内细菌是否污染切口及围手术期抗生素的使用有明显的关系 ,手术中应加强预防 ,以减少切口感染     

关节置换术后手术部位感染细菌的抗生素敏感性研究

背景：目前，对于治疗疑似全髋或全膝关节置换术后假体周围感染的抗生素使用原则还没有共识。本研究旨在建立这样一个用药原则。方法：对146例患者进行回顾性研究。在这些患者进行全髋或全膝关节置换术后的翻修术时，共194个标本得到了细菌培养阳性结果。患者的一般信息、并存疾病情况、细菌种类、抗生素敏感性资料以及翻修术后细菌培养出现阳性结果所需要的天数均被记录。结果：共110髋、84膝得到的标本培养结果为阳性。其中70％为慢性感染，17％为急性术后局部感染，13％为急性血源性感染。翻修术后出现阳性培养结果的平均时间为3天。革兰氏阳性菌感染占绝大多数。在这些细菌中，88％对庆大霉素敏感，96％对万古霉素敏感，61％对头孢唑林敏感。多数的耐药菌来自于先前有过抗生素治疗失败史的患者。术后急性感染的菌株比慢性感染或血源性感染的菌株更易发生耐药。血源性感染患者分离得到的菌株对庆大霉素和头孢唑林都有高度的敏感性。结论：对疑似假体周围感染的经验性抗生素用药应该在对感染进行分类和确定革兰氏染色结果的指导下进行。我们认为，在得到培养结果之前，急性血源性感染应该一开始就使用头孢唑林和庆大霉素的联合治疗。所有术后慢性或急性革兰氏阳性菌感染或不能明确革兰氏染色结果的细菌感染都应该用万古霉素。革兰氏阴性菌感染应该用第三代或第四代头孢霉素。革兰氏阳性菌和阴性菌的混合感染应该联合使用万古霉素和第三代或第四代头孢霉素。另外，我们认为如果在术后第4天还没有得到细菌培养或是其他确诊的阳性结果就应该结束经验性抗生素治疗。可信水平：诊断性研究，Ⅳ级。进一步可信度参见作者介绍。     

手术部位感染高危因素与预防

手术部位感染(surgical site infection,SSI)简称切口感染,仍然是当今外科医生面临的棘手问题之一,由此给病人带来的痛苦,给社会增加的经济负担日益引起人们的重视。由于我国尚没有公布符合中国国情的SSI预防指南,本文根据国外近年文献,筛选出与普通外科有关的SSI高危因素,并提出预防措施。1SSI定义SSI是指手术期(或在围手术期以后)发生的感染,占住院病人院内感染总数的14%~38%,是院内感染的第三大原因,仅次于泌尿系统感染和肺炎[1-2]。根据美国疾病控制与预防中心颁布的SSI预防指南的原始文献定义,按SSI发生的部位分为切口浅部感…     

腹腔镜Ⅱ类切口手术围手术期抗生素应用时间对手术部位感染影响的前瞻性研究

目的通过前瞻性随机对照实验研究,探讨腹腔镜Ⅱ类切口手术围手术期抗生素的应用价值。方法将2014-02—2016-02间在开封市中心医院择期行腹腔镜Ⅱ类切口手术患者231例随机分为2组。观察组117例,术前及术后48 h内预防性应用抗生素;对照组114例,术前及术后24 h内预防性应用抗生素。比较2组患者术后切口感染率、体温、白细胞计数及中性粒细胞比例、住院时间及胃肠道功能恢复时间。结果 2组患者术后切口感染率、住院时间、胃肠道功能恢复时间比较,差异无统计学意义(P0.05)。结论延长腹腔镜Ⅱ类切口手术围手术期抗生素应用时间,不能降低术后手术部位感染率。     

碘伏原液浸泡对阑尾Ⅲ类手术切口手术部位感染的预防效果

目的 探讨碘伏原液浸泡对于预防阑尾Ⅲ类手术切口手术部位感染（SSI）的疗效。方法 回顾性分析笔者所在医院2012年5月至2013年5月期间施行阑尾切除术者中切口类型为Ⅲ类的92例患者的临床资料,比较以碘伏原液浸泡切口（浸泡组）和冲洗切口（常规组）处理后患者的切口愈合情况。结果 术后常规组57例患者中,有43例切口愈合等级为甲级,5例为乙级,9例为丙级,SSI发生率为24.56% （14/57）。浸泡组35例患者的切口愈合均良好,均为甲级愈合,SSI发生率为0,低于常规组（P＜0.05）。结论 采用碘伏原液浸泡切口5 min能有效预防阑尾炎Ⅲ类切口SSI的发生,值得临床推广应用。     

呼吸机管道使用时间对呼吸道细菌定植的影响

目的了解呼吸机管道使用时间对机械通气患者呼吸道细菌定植的影响,为降低呼吸机相关性肺炎采取针对性护理措施提供参考。方法选择使用一次性密闭式双加热呼吸机湿化管道系统机械通气时间超过336h的患者30例,分别于上机72h、168h、240h、336h采集患者咽喉部、下呼吸道分泌物进行细菌培养。结果咽喉部细菌定植以鲍曼不动杆菌为主,其次为杂菌;下呼吸道细菌定植以鲍曼不动杆菌最多,其次为铜绿假单胞菌及真菌。呼吸机管道使用不同时间段呼吸道细菌培养结果比较,差异有统计学意义(P<0.05、P<0.01)。结论机械通气患者随着呼吸机管道使用时间的延长,咽喉部及下呼吸道的细菌培养阳性率显著增加。需依据患者使用的呼吸机管道类型、湿化类型、管道污染情况及基础疾病等选择最佳的呼吸机管道更换时机。     

神经外科患儿手术部位感染预防的循证实践

目的 降低神经外科患儿手术部位感染发生率.方法 遵循JBI循证护理中心应用模式,应用循证方法获取最佳证据,制订11条审查标准,以基于证据的持续质量改进模式为理论框架,于2020年11月至2021年4月,按照基线审查、实践变革和证据应用后变革效果的再审查将循证实践应用于神经外科手术患儿,比较循证实践前后医护人员证据应用的依从性和患儿手术部位感染率等.结果 循证实践后,除第6和8条审查指标执行效果不理想外,其余待改进条目中医护人员预防手术部位感染证据应用的依从性均有提高,差异有统计学意义(P＜0.01),临床护理流程更加规范化,患儿手术部位感染率和平均住院天数显著降低(均P＜0.05).医护人员和患儿照护者预防手术部位感染知识知晓程度也有显著提高(均P＜0.01).结论 通过循证实践的持续改进对神经外科手术患儿进行管理,可有效规范围术期医护人员诊疗护理行为,降低手术部位感染率,缩短住院时间,后期仍需持续质量监控及审查.     

抗感染中心静脉导管在减少导管相关性感染和细菌定植中的临床随机对照研究

目的 比较用磺胺嘧啶银和洗必泰抗感染的中心静脉导管(CVC)与普通导管在减少细菌定植和导管相关性感染方面的差异.方法 采用前瞻性、随机对照分析方法,对2007年6月-2009年6月武警总医院ICU收治的70例需要深静脉置管患者进行随机分组,留置双腔抗感染CVC(抗感染组,n=28)和双腔普通CVC(对照组,n=42),...     

Usefulness of Absorbable Sutures in Preventing Surgical Site Infection in Hepatectomy

We evaluated the usefulness of synthetic absorbable sutures (Vicryl) in preventing surgical site infection (SSI) after hepatectomy. A rat model of 60% partial hepatectomy was used. Bleeding from the cut surface of the liver was controlled by using two suture types: silk and Vicryl. In the Vicryl group, the lesser omentum was slightly adherent to the cut surface of the liver, while in the silk group, the suture remained, and severe adhesions were found. The number of Staphylococcus aureus was significantly larger in the silk group. We compared a group of patients (n = 125) who underwent hepatectomy using silk with one (n = 188) using Vicryl. The respective incidences of SSI and infection on the cut surface of the liver in the Vicryl group (3.2, 1.6%) were significantly lower than in the silk group (11.2, 8.8%). In accordance with the results of multivariate analysis, duration of operation, use of silk sutures and the complication of bile leakage were selected as independent factors. The risk of SSI in the silk group was 3.4 times that in the Vicryl group. The use of synthetic absorbable sutures, instead of silk sutures, in all the procedures of hepatectomy contributed significantly to the prevention of SSI.     

Particular Features of Surgical Site Infection in Posterior Lumbar Interbody Fusion

Background

Previous reports have observed differences only in infection rates between posterolateral fusion and posterior lumbar interbody fusion (PLIF). There have been no reports that describe the particular features of surgical site infection (SSI) in PLIF. In this study, we endeavor to identify the distinguishing characteristics and risk factors of SSI in PLIF.

Methods

Our study undertook a review of a case series of an institute. Patients who had undergone PLIF consecutively in the author''s hospital were reviewed. Two proactive procedures were introduced during the study period. One was irrigation of the autolocal bone, and the other was the intradiscal space irrigation with a nozzle. Infection rate and risk factors were analyzed. For subgroup analysis, the elapsed time to a diagnosis (ETD), clinical manifestations, hematologic findings, and causative bacteria were examined in patients with SSI.

Results

In a total of 1,831 cases, there were 30 cases of SSI (1.6%). Long operation time was an independent risk factor (p = 0.008), and local bone irrigation was an independent protective factor (p = 0.001). Two cases of referred SSI were included in the subgroup analysis. There were 6/32 (19%) superficial incisional infections (SII), 6/32 (19%) deep incisional infections (DII), and 20/32 (62%) organ/space infections (O/SI). The difference of incidence among three groups was significant (p = 0.002).The most common bacteria encountered were methicillin-resistant Staphylococcus epidermidis followed by methicillin-resistant S. aureus in incisional infections, and no growth followed by S. epidermidis in O/SI. ETD was 8.5 ± 2.3 days in SII, 8.7 ± 2.3 days in DII and 164.5 ± 131.1 days in O/SI (p = 0.013).

Conclusions

The rate of SSI in PLIF was 1.6%, with the most common type being O/SI. The causative bacteria of O/SI was of lower virulence than in the incisional infection, and thus diagnosis was delayed due to its latent and insidious feature. Contamination of auto-local bone was presumed attributable to the progression of SSI. Irrigation of auto-local bone helped in the reduction of SSI.     

Favorable Effects of Preoperative Enteral Immunonutrition on a Surgical Site Infection in Patients with Colorectal Cancer Without Malnutrition

Purpose A prospective study was conducted to ascertain the effects of preoperative enteral immunonutrition on a surgical site infection (SSI) in patients with colorectal cancer without malnutrition. Methods Patients with colorectal cancer undergoing elective surgery without malnutrition, bowel obstruction, severe cardiopulmonary complications, diabetes, collagen disease, or renal failure were sequentially divided into an immunonutrition group (n = 33) and a control group (n = 34). In the immunonutrition group, an enteral diet supplemented with arginine, dietary nucleotides, and ω-3 fatty acids was administered for 5 days (750 ml/day) prior to surgery. Results The mean age was slightly higher in the immunonutrition group (69 ± 9 years) than in the control group (63 ± 11 years; P < 0.05), but no significant differences between the groups were noted for the body mass index, total protein, albumin, hemoglobin, surgical methods, operation time, or volume of intraoperative bleeding. The frequencies of superficial incisional SSI, deep incisional SSI and organ/space SSI in the immunonutrition and control groups were 0% and 11.8% (4/34; P < 0.05), 0% and 0%, and 0% and 2.9% (1/34), respectively. Conclusion Preoperative enteral immunonutrition appears to be effective for preventing SSI in patients with colorectal cancer without malnutrition.     

Impact of Oral Antimicrobial Prophylaxis on Surgical Site Infection and Methicillin-Resistant Staphylococcus aureus Infection After Elective Colorectal Surgery. Results of a Prospective Randomized Trial

The impact of oral antimicrobial prophylaxis on the surgical site infection and methicillin-resistant Staphylococcus aureus (MRSA) infection after elective colorectal surgery was evaluated by a prospective randomized single-blind study. The patients were randomly allocated to receive either mechanical bowel cleansing with polyethylene glycol alone (group 1) or mechanical cleansing plus oral antimicrobial prophylaxis with kanamycin and erythromycin for 2 days prior to surgery (group 2). In both groups, cefotiam was intravenously given twice a day for 3 days. A total of 143 patients (71 for group 1 and 72 for group 2) were eligible. The incidence of a surgical site infection was 23.9% in group 1 and 11.1% in group 2 (P = 0.04). The incidence of MRSA infection including at surgical and remote sites was 11.1% in group 1 and 5.6% in group 2 (P = 0.19). A multivariate logistic regression analysis showed that the risk of surgical site infection was influenced by the choice of the chemical bowel preparation (P = 0.03) and blood loss (P < 0.01), while an MRSA infection was predominantly influenced by blood loss (P < 0.01) followed by coexisting underlying diseases (P = 0.07). These results suggest that preoperative antimicrobial prophylaxis would be useful for reducing the incidence of a surgical site infection without increasing the risk of an MRSA infection following elective colorectal surgery. Received: February 6, 2001 / Accepted: July 17, 2001     

集束式干预措施预防腹股沟疝无张力修补术手术部位感染的随机对照研究

目的探索集束式干预措施对于预防腹股沟疝修补术手术部位感染的效果。 方法收集2016年12月至2017年10月,四川省人民医院125例腹股沟疝修补术手术患者,其中117例（93.6%）完成研究。采用随机对照试验,将腹股沟疝修补术患者按照随机数字表法分为干预组和对照组。干预组54例,实施集束式干预措施（术前洗必泰沐浴、电动备皮器备皮、手术当天备皮、使用洗必泰醇复方成分的皮肤消毒剂）;对照组63例,采用常规措施。按照美国NHSN 2013年手术部位感染监测定义和监测方法,观察和比较2组患者的手术部位感染发生率和医疗成本消耗情况。 结果干预组腹股沟疝修补术手术部位感染发生率3.70%（2/54）,对照组12.70%（8/63）,2组比较,差异无统计学意义（χ²=1.969,P=0.161）;干预组平均住院时间7（4～32）d,对照组8（3～45）d,2组比较,差异有统计学意义（Z=－1.995,P=0.046）;干预组平均治疗总费用10 655.00（7 295.51～28 917.02）元,对照组11 737.96（7 953.61～24 103.04）元,2组比较,差异有统计学意义（Z=－2.433,P=0.015）。 结论暂未观察到集束式干预措施可显著降低腹股沟疝修补术手术部位感染的发生率,其有效性有待进一步研究确认;但集束式干预措施可有效缩短腹股沟疝修补术患者平均住院时间和平均治疗费用,从而提高医疗资源利用率、医院的收入,降低医疗费用支出。