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本帖最后由 谷子 于 2024-1-1 12:03 编辑
Surgical Site Infection Prevention: A ReviewJAMA
Jan 17, 2023: 329 (3,), 244-252
10.1001/jama.2022.24075
ImportanceApproximately 0.5% to 3% of patients undergoing surgery will experience infection at or adjacent to the surgical incision site. Compared with patients undergoing surgery who do not have a surgical site infection, those with a surgical site infection are hospitalized approximately 7 to 11 days longer.
大约0.5%至3%的接受手术的患者将在手术切口部位或其附近经历感染。与没有手术部位感染的接受手术的患者相比，手术部位感染患者的住院时间约长7至11天。
ObservationsMost surgical site infections can be prevented if appropriate strategies are implemented. These infections are typically caused when bacteria from the patient’s endogenous flora are inoculated into the surgical site at the time of surgery. Development of an infection depends on various factors such as the health of the patient’s immune system, presence of foreign material, degree of bacterial wound contamination, and use of antibiotic prophylaxis. Although numerous strategies are recommended by international organizations to decrease surgical site infection, only 6 general strategies are supported by randomized trials. Interventions that are associated with lower rates of infection include avoiding razors for hair removal (4.4% with razors vs 2.5% with clippers); decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures (0.8% with decolonization vs 2% without); use of chlorhexidine gluconate and alcohol-based skin preparation (4.0% with chlorhexidine gluconate plus alcohol vs 6.5% with povidone iodine plus alcohol); maintaining normothermia with active warming such as warmed intravenous fluids, skin warming, and warm forced air to keep the body temperature warmer than 36 °C (4.7% with active warming vs 13% without); perioperative glycemic control (9.4% with glucose <150 mg/dL vs 16% with glucose >150 mg/dL); and use of negative pressure wound therapy (9.7% with vs 15% without). Guidelines recommend appropriate dosing, timing, and choice of preoperative parenteral antimicrobial prophylaxis.
如果采取适当的策略，大多数手术部位感染都可以预防。这些感染通常是在手术时将患者内源性菌群中的细菌接种到手术部位时引起的。感染的发展取决于各种因素，如患者免疫系统的健康状况、异物的存在、细菌伤口污染的程度以及抗生素预防的使用。尽管国际组织推荐了许多减少手术部位感染的策略，但只有6种通用策略得到了随机试验的支持。与较低感染率相关的干预措施包括避免使用剃须刀脱毛（使用剃须刀4.4%，使用剪子2.5%）；使用鼻内抗葡萄球菌药物和抗葡萄球菌皮肤防腐剂进行高风险手术的去殖民化（有去殖民化的0.8%与没有去殖民化的2%）；使用葡萄糖酸氯己定和基于酒精的皮肤制剂（葡萄糖酸氯已定加酒精为4.0%，聚维酮碘加酒精为6.5%）；通过主动加温（如加温静脉输液、皮肤加温和温暖的强制空气）保持体温正常，以保持体温高于36°C（主动加温4.7%，不主动加温13%）；围手术期血糖控制（葡萄糖<150 mg/dL时为9.4%，葡萄糖>150 mg/dL时为16%）；以及使用负压伤口治疗（9.7%有vs 15%无）。指南建议适当的给药、时间和术前胃肠外抗菌预防的选择。
Conclusions and RelevanceSurgical site infections affect approximately 0.5% to 3% of patients undergoing surgery and are associated with longer hospital stays than patients with no surgical site infections. Avoiding razors for hair removal, maintaining normothermia, use of chlorhexidine gluconate plus alcohol–based skin preparation agents, decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures, controlling for perioperative glucose concentrations, and using negative pressure wound therapy can reduce the rate of surgical site infections.
手术部位感染影响大约0.5%至3%的接受手术的患者，并且与没有手术部位感染的患者相比，住院时间更长。避免使用剃须刀脱毛，保持常温，使用葡萄糖酸氯己定加酒精类皮肤制剂，在高危手术中使用鼻内抗葡萄球菌制剂和抗葡萄球菌皮肤防腐剂去殖民化，控制围手术期葡萄糖浓度，并且使用负压伤口治疗可以降低手术部位感染的比率。
附英文原文章：
手术部位感染-综述2023年.pdf
(189.22 KB, 下载次数: 44, 售价: 1 枚金币)
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发表于 2023-12-29 16:44
发表于 2023-12-29 17:08