抗生素耐药性高的手术预防的有效性

M. Aydın, Esra Nur Karadogan, A. Kadanalı
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摘要

目的:探讨外科手术部位感染(SSI)的危险因素及预防性使用抗生素的效果。方法:回顾性分析2014年1月1日至2019年12月31日行胆囊切除术、阴道子宫切除术、膝关节假体、髋关节假体和胃手术的SSI患者的人口学特征、合并症和微生物学检查。医疗保健相关感染和SSI的诊断是基于疾病控制和预防中心的标准。结果:我们在30%的膝关节假体感染(60%碳青霉烯耐药)、60%的髋关节假体感染(39%碳青霉烯耐药)、36%的阴道子宫切除术(无碳青霉烯耐药)、50%的胆囊切除术(无碳青霉烯耐药)和20%的胃手术(无碳青霉烯耐药)中检测到革兰氏阴性菌。葡萄球菌是30%的膝关节假体感染(30%耐甲氧西林)和20%的髋关节假体感染(38%耐甲氧西林)的病原体。结论:我们检测到膝关节和髋关节置换术感染分离的微生物的多药耐药。抗生素耐药性是一个大问题,抗生素预防不足以预防SSI。当发生SSI时,医生应密切随访手术患者,并采集微生物样本,选择合适的抗生素。
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Effectiveness of Surgical Prophylaxis Where the Antibiotic Resistance is High
Objective: We aimed to investigate the risk factors for surgical site infections (SSI) and the effectiveness of prophylactic antibiotic use. Methods: The demographic characteristics, comorbidities, and microbiological examinations of patients diagnosed with SSI who had a cholecystectomy, vaginal hysterectomy, knee prosthesis, hip prosthesis, and gastric surgery between January the 1st, 2014 and December the 31st, 2019 were retrospectively analysed. The diagnosis of healthcare-associated infections and SSI was based on the Centers for Disease Control and Prevention criteria. Results: We detected Gram-negative bacteria in 30% of knee prosthesis infections (60% carbapenem-resistant), 60% of hip prosthesis infections (39% carbapenem-resistant), 36% of vaginal hysterectomy (no carbapenem resistance), 50% of cholecystectomy (no carbapenem resistance), and 20% of gastric surgery (no carbapenem resistance). Staphylococci were the causative agents in 30% of knee prosthesis infections (30% methicillin-resistant) and 20% of hip prosthesis infections (38% methicillin-resistant). Conclusion: We detected multidrug resistance in microorganisms isolated from knee and hip replacement infections. Antibiotic resistance is a big problem, and antibiotic prophylaxis is insufficient to prevent SSI. Doctors should follow up with the patient who underwent surgery closely and take microbiological samples to select appropriate antibiotics when SSI develops.
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