比较两种减少结直肠手术手术部位感染的捆绑方法:多中心队列研究。

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-07-02 DOI:10.1093/bjsopen/zrae080
Miriam Flores-Yelamos, Aina Gomila-Grange, Josep M Badia, Alexander Almendral, Ana Vázquez, David Parés, Marta Pascual, Enric Limón, Miquel Pujol, Montserrat Juvany
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引用次数: 0

摘要

背景:关于手术部位感染预防捆绑包中可包含的要素的最大数量存在争议。此外,这种类型的捆绑包能否在多中心水平上实施还不清楚:方法:设计了一项务实的多中心队列研究,分析在依次实施两种预防捆绑方案后,择期结直肠手术的手术部位感染率。次要结果是确定各项措施的依从性,并确定其有效性、住院时间、微生物学和 30 天死亡率:结果:共纳入 32 205 名患者。在连续实施两套捆绑方案后,手术部位感染率降低了 50%:从基线组的 18.16% 降至捆绑方案 1 的 10.03%,捆绑方案 2 的 8.19%。捆绑-2 降低了浅表手术部位感染(OR 0.74 (95% c.i. 0.58 to 0.95); P = 0.018)和深部手术部位感染(OR 0.66 (95% c.i. 0.46 to 0.93); P = 0.018),但没有降低器官/空间手术部位感染(OR 0.88 (95% c.i. 0.74 to 1.06); P = 0.172)。在 Bundle-2 中增加四项措施后,依从性有所提高。在多变量分析中,就器官/空间手术部位感染而言,腹腔镜、口服抗生素预防和机械肠道准备是结肠手术的保护因素,而直肠手术则没有保护因素。随着时间的推移,住院时间明显缩短,Bundle-1 和 Bundle-2 组分别从 7 天和 5 天缩短到 6 天和 5 天(P < 0.001)。死亡率从基线组的 1.4% 降至 Bundle-1 组的 0.59%,Bundle-2 组的 0.6%(P < 0.001)。在器官/空间-手术部位感染中,革兰氏阳性菌和酵母菌分离率上升,革兰氏阴性菌和厌氧菌分离率下降:增加措施以创建最终的 10 项措施方案对减少手术部位感染具有累积保护作用。然而,器官/空间手术部位感染并没有从增加的措施中受益。在直肠手术中没有发现针对器官/空间手术部位感染的保护措施。从 Bundle-1 到 Bundle-2,预防措施的依从性有所提高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study.

Background: There is controversy regarding the maximum number of elements that can be included in a surgical site infection prevention bundle. In addition, it is unclear whether a bundle of this type can be implemented at a multicentre level.

Methods: A pragmatic, multicentre cohort study was designed to analyse surgical site infection rates in elective colorectal surgery after the sequential implementation of two preventive bundle protocols. Secondary outcomes were to determine compliance with individual measures and to establish their effectiveness, duration of stay, microbiology and 30-day mortality rate.

Results: A total of 32 205 patients were included. A 50% reduction in surgical site infection was achieved after the implementation of two sequential sets of bundles: from 18.16% in the Baseline group to 10.03% with Bundle-1 and 8.19% with Bundle-2. Bundle-2 reduced superficial-surgical site infection (OR 0.74 (95% c.i. 0.58 to 0.95); P = 0.018) and deep-surgical site infection (OR 0.66 (95% c.i. 0.46 to 0.93); P = 0.018) but not organ/space-surgical site infection (OR 0.88 (95% c.i. 0.74 to 1.06); P = 0.172). Compliance increased after the addition of four measures to Bundle-2. In the multivariable analysis, for organ/space-surgical site infection, laparoscopy, oral antibiotic prophylaxis and mechanical bowel preparation were protective factors in colonic procedures, while no protective factors were found in rectal surgery. Duration of stay fell significantly over time, from 7 in the Baseline group to 6 and 5 days for Bundle-1 and Bundle-2 respectively (P < 0.001). The mortality rate fell from 1.4% in the Baseline group to 0.59% and 0.6% for Bundle-1 and Bundle-2 respectively (P < 0.001). There was an increase in Gram-positive bacteria and yeast isolation, and reduction in Gram-negative bacteria and anaerobes in organ/space-surgical site infection.

Conclusions: The addition of measures to create a final 10-measure protocol had a cumulative protective effect on reducing surgical site infection. However, organ/space-surgical site infection did not benefit from the addition. No protective measures were found for organ/space-surgical site infection in rectal surgery. Compliance with preventive measures increased from Bundle-1 to Bundle-2.

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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
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144
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