癌症患者同种异体材料重建手术中感染性并发症的主要诱因

A. E. Gulyaeva, E. A. Kim, Z. Grigorievskaya, D. Denchik, K. V. Gagulaeva, D. Khaylenko, A. A. Rumyantsev, A. Petrovsky
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This is especially relevant for oncoplastic surgery, since in most cases the installation of foreign materials (expanders, implants, meshes) is required to achieve a satisfactory cosmetic result.The purpose of the study: to identify the most common cause of infectious complications after reconstructive operations on the mammary gland using endoprostheses.Materials and methods: In a retrospective review of 526 consecutive implant-based breast reconstructions at a single institution from June 2020 to June 2022 was conducted. The frequency of development of infectious complications was assessed, as well as the taxonomic structure of the main pathogens that were isolated in the department of oncomammology in 2020–2022.Results: The incidence of infectious complications that led to the loss of the endoprosthesis during reconstructive surgery on the mammary gland was 6.7 %. The main causative agents of SSI leading to the loss of implants and the need for reoperations were Corynebacterium striatum (35.2 %) and Staphylococcus aureus (27.2 %). The spectrum of the most common pathogens that led to the loss of implants corresponded to the flora most often detected during bacterial culture in the department. The probability of implant loss was higher in the group of patients who underwent chemotherapy (14 of 197, 7.1 %) or chemoradiotherapy (14 of 188, 7.4 %) compared with patients who did not receive specific anticancer treatment (7 of 141, 4.9 %). However, taking patients who did not receive drug or radiation treatment as a reference group, statistical significance could not be achieved (p = 0.56 in the chemotherapy group and p = 0.49 in the chemoradiotherapy group).Conclusions: Our own experience has shown that, despite the current preventive measures, the frequency of infectious complications remains quite high. 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引用次数: 0

摘要

引言:手术部位感染(SSI)是外科实践中的关键问题之一。尽管现代医学取得了成就,正在采取预防措施,但伤口感染的发生率仍然相当高。这与肿瘤整形手术尤其相关,因为在大多数情况下,需要安装异物(扩张器、植入物、网状物)才能获得令人满意的美容效果。本研究的目的:确定使用内假体进行乳腺重建手术后感染性并发症的最常见原因。材料和方法:对2020年6月至2022年6月在一家机构连续进行的526次基于植入物的乳房重建进行了回顾性审查。评估了感染性并发症的发生频率,以及2020-2022年在肿瘤学系分离的主要病原体的分类结构。结果:在乳腺重建手术中,导致内假体丢失的感染性并发症发生率为6.7%。导致植入物丢失和需要再次手术的SSI的主要病原体是纹状体棒状杆菌(35.2%)和金黄色葡萄球菌(27.2%)。导致植入物丢失的最常见病原体的谱与该部门细菌培养过程中最常检测到的菌群相对应。与未接受特定抗癌治疗的患者(7/141,4.9%)相比,接受化疗(14/197,7.1%)或放化疗(14/188,7.4%)的患者组植入物丢失的概率更高。然而,将未接受药物或放射治疗的患者作为参考组,无法达到统计学意义(化疗组p=0.56,放化疗组p=0.49)。结论:我们自己的经验表明,尽管目前采取了预防措施,但感染性并发症的发生率仍然很高。在SSI病原体的病原学结构中,葡萄球菌属和棒状杆菌属微生物占主导地位。在围手术期预防中使用广谱抗生素并不能保证术后无SSI。分析分离的病原体对抗菌药物的敏感性,评估未来各种抗生素方案的有效性,可能使我们能够为乳房重建手术中的感染性并发症制定最佳的抗生素预防方案,因此,需要在这方面进行进一步的前瞻性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The main causative agents of infectious complications during reconstructive surgery using allomaterials in patients with breast cancer
Introduction: Surgical site infections (SSI) are one of the key problems in surgical practice. Despite the achievements of modern medicine, ongoing preventive measures, the incidence of wound infection remains quite high. This is especially relevant for oncoplastic surgery, since in most cases the installation of foreign materials (expanders, implants, meshes) is required to achieve a satisfactory cosmetic result.The purpose of the study: to identify the most common cause of infectious complications after reconstructive operations on the mammary gland using endoprostheses.Materials and methods: In a retrospective review of 526 consecutive implant-based breast reconstructions at a single institution from June 2020 to June 2022 was conducted. The frequency of development of infectious complications was assessed, as well as the taxonomic structure of the main pathogens that were isolated in the department of oncomammology in 2020–2022.Results: The incidence of infectious complications that led to the loss of the endoprosthesis during reconstructive surgery on the mammary gland was 6.7 %. The main causative agents of SSI leading to the loss of implants and the need for reoperations were Corynebacterium striatum (35.2 %) and Staphylococcus aureus (27.2 %). The spectrum of the most common pathogens that led to the loss of implants corresponded to the flora most often detected during bacterial culture in the department. The probability of implant loss was higher in the group of patients who underwent chemotherapy (14 of 197, 7.1 %) or chemoradiotherapy (14 of 188, 7.4 %) compared with patients who did not receive specific anticancer treatment (7 of 141, 4.9 %). However, taking patients who did not receive drug or radiation treatment as a reference group, statistical significance could not be achieved (p = 0.56 in the chemotherapy group and p = 0.49 in the chemoradiotherapy group).Conclusions: Our own experience has shown that, despite the current preventive measures, the frequency of infectious complications remains quite high. In the etiological structure of SSI pathogens, microorganisms of the genera Staphylococcus and Corynebacterium predominate. The use of broad-spectrum antibiotics in perioperative prophylaxis did not guarantee the absence of SSI in the postoperative period. An analysis of the sensitivity of isolated pathogens to antibacterial drugs, an assessment of the effectiveness of various antibiotic regimens in the future may allow us to develop an optimal antibiotic prophylaxis scheme for infectious complications during breast reconstructive surgery, therefore, further prospective studies in this direction are needed.
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