组织工程与重建外科杂志 ›› 2013, Vol. 9 ›› Issue (5): 263-267.doi: 10.3969/j.issn.1673-0364.2013.05.006

• 论著 • 上一篇    下一篇

瘢痕组织对手术部位感染及细菌定植的影响

刘文辉,黄晓璐,谢芸,李青峰   

  1. 上海交通大学医学院附属第九人民医院整复外科
  • 发布日期:2020-07-23

The Influence of Scar Tissue on Surgical Site Infection and Bacterial Colonization

LIU Wenhui,HUANG Xiaolu,XIE Yun,LI Qingfeng   

  1. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital,Shanghai Jiaotong University School of Medicine
  • Published:2020-07-23
  • Contact: 上海市市级医院新兴前沿技术联合攻关项目(no:shdc12010105)

摘要: 目的比较瘢痕组织与正常皮肤术后切口感染率差异,探索瘢痕组织与正常手术部位主要病原菌的定植差异,以及对常用抗生素的耐药性。方法采用前瞻性队列研究设计,根据手术切口是否经过瘢痕,将我院2010年至2012年接受整复外科手术的129例患者分为瘢痕组和非瘢痕组,收集两组患者的一般人口学特征、细菌定植的危险因素及可能的混杂因素。根据卫生部指南,确定是否发生手术部位感染,分析瘢痕对手术部位感染率的影响。术前对两组手术部位进行微生物采样培养与检测,用多因素Logistic回归分析瘢痕组多个危险因素与细菌定植的关联,并对主要病原菌进行抗生素敏感性分析,以确定其定植模式。结果瘢痕组手术部位感染率及病原菌阳性率,分别是非瘢痕组的2.3倍(4.8%比2.1%,P<0.05)与1.4倍(73.2%比53.2%,P<0.05)。与细菌定植关联较强的危险因素包括电击伤、创伤、化学物质、瘢痕组织解剖学位置等。最常见的主要病原菌是金黄色葡萄球菌(22.4%),其中19.4%的金黄色葡萄球菌具有多重耐药性。结论瘢痕组织是手术切口感染的独立危险因素,且比正常手术部位定植有更多的耐药菌。细菌定植与多种病因学因素及解剖位置有较强关联。

关键词: 瘢痕组织, 手术切口感染, 细菌定植

Abstract: Objective To compare the surgical site infection rate of scar tissue and normal tissue; To determine the difference of leading pathogens colonization and their resistance to common antibiotics between scar tissue and normal tissue. Methods A prospective cohort study was conducted among 129 patients who received plastic and reconstructive surgery and were divided into scar group or non-scar group according to whether scars were involved in their surgery or not. Data on background information, risk factor for bacterial colonization and related confounding factors were collected. The diagnose criteria of SSI was in consistence with the guideline of the Ministry of Health. Microorganism specimen was taken before the surgery. Further identification was undertaken to determine the colonization pattern by antibiotics sensitivity analysis. Multiple Logistic regression analysis was conducted to investigate the association between risk factors and bacterial colonization profile. Results Scar tissue was featured with more surgical site infection (2.3 times, 4.8% vs. 2.1%, P<0.05) and bacterial colonization (1.4 times, 73.2%vs. 53.2%, P<0.05) than normal tissue. Bacterial colonization of scar tissue was significantly connected with factors such as electricity, trauma, chemical injury, site of head and neck. Staphylococcus aureus, as the most common leading pathogen, accounted for 22.4% of all the pathogens and 19.4% of it was found multiple antibiotic resistant. Conclusion Scar tissue is an independent risk factor for surgical site infection with more antibiotic resistant bacteria than normal tissue. Bacterial colonization was significantly related to several etiological factors and anatomic site.

Key words: Scar tissue, Surgical site infection, Bacterial colonization

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