JAMA：降低手术部位感染的措施

2015-07-09 阮秀荣（译）医学论坛网

据《美国医学会杂志》(JAMA)近日报道，一些措施，包括识别鼻腔金黄色葡萄球菌的载体并去除其定植，优化围手术期的抗生素预防性应用及给予耐甲氧西林金黄色葡萄球菌感染患者万古霉素，已被证明可降低金黄色葡萄球菌所致的手术部位感染(SSIs)的发生率。目前，研究者们开展了一项多中心试验，对这三种干预措施联合应用于心脏术后及髋或膝关节置换术后预防复杂的SSIs(如深部切口)的效果进行了研究。在美国9个州

据《美国医学会杂志》(JAMA)近日报道，一些措施，包括识别鼻腔金黄色葡萄球菌的载体并去除其定植，优化围手术期的抗生素预防性应用及给予耐甲氧西林金黄色葡萄球菌感染患者万古霉素，已被证明可降低金黄色葡萄球菌所致的手术部位感染(SSIs)的发生率。目前，研究者们开展了一项多中心试验，对这三种干预措施联合应用于心脏术后及髋或膝关节置换术后预防复杂的SSIs(如深部切口)的效果进行了研究。

在美国9个州的20家城市医院中，对5年间干预前期和干预期间的SSI率进行了对比研究。细菌去定植的方法是一日2次鼻内给予莫匹罗星、每日使用葡萄糖酸氯己定冲洗，连续5天。术后对患者进行了90天的随访。

干预前期和干预期的中位时间分别为39个月和21个月。每万例手术中金黄色葡萄球菌所致复杂性SSIs的月均总发生率从干预前的36(例)降低为干预期的21例(P=0.02)，但该降低只发生在髋或膝盖关节置换术的患者中，接受心脏手术的患者并未发生此降低。此外，只有完全执行该联合疗法的患者才出现此发生率的降低，紧急手术患者的依从性较按期手术患者的依从性低。其他病原菌而非金黄色葡萄球菌所致的SSIs率并没有显著降低。

此试验中研究的简便预防措施可在任何医疗机构中应用。不过，这些措施需要全面应用，而且在紧急情况下应用可能存在问题。社论强调该试验的设计存在潜在局限性：本试验中涉及的医院均属于同一医疗卫生系统，因此此系统中的其他因素可能对试验结果造成影响。

原始出处：

Marin L. Schweizer, PhD1,2,3; Hsiu-Yin Chiang, MS, PhD1; Edward Septimus, MD4,5; Julia Moody, MS4; Barbara Braun, PhD6; Joanne Hafner, RN, MS6; Melissa A. Ward, MS1; Jason Hickok, MBA, RN4; Eli N. Perencevich, MD, MS1,2; Daniel J. Diekema, MD1; Cheryl L. Richards, MJ, LPN, LMT6; Joseph E. Cavanaugh, PhD3; Jonathan B. Perlin, MD, PhD4; Loreen A. Herwaldt, MD1,3,7.Association of a Bundled Intervention With Surgical Site Infections Among Patients Undergoing Cardiac, Hip, or Knee Surgery.JAMA.June 2, 2015. doi:10.1001/jama.2015.5387.

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2016-01-27 doctording1

值得进一步关注

122 0
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2016-01-27 doctording1

是一篇不错的文章

135 0
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2016-01-27 doctording1

这篇文章有一定深度

135 0
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2016-01-27 doctording1

不错，赞一个

117 0
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2015-10-05 1ddcfa8bm07(暂无匿称)

学习～

132 0
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2015-07-14 lovejing

这种操作需要患者同意，所以有难度

83 0
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2015-07-12 huaxipanxing

看看

107 0
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2015-07-11 飞翔9899

内容太短了

104 0
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2015-07-11 wleon8895

#手术部位感染#

27 0
[GetPortalCommentsPageByObjectIdResponse(id=61651, encodeId=9cf261651cd, content=值得进一步关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Wed Jan 27 23:53:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61650, encodeId=62b561650b1, content=是一篇不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Wed Jan 27 23:53:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61649, encodeId=116361649a0, content=这篇文章有一定深度, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Wed Jan 27 23:53:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61648, encodeId=f3676164831, content=不错，赞一个, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Wed Jan 27 23:53:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=37708, encodeId=78a13e7088c, content=学习～, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=754a1652870, createdName=1ddcfa8bm07(暂无匿称), createdTime=Mon Oct 05 15:45:00 CST 2015, time=2015-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32717, encodeId=929532e17c1, content=这种操作需要患者同意，所以有难度, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9e0b1603164, createdName=lovejing, createdTime=Tue Jul 14 11:11:00 CST 2015, time=2015-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32506, encodeId=f10f32506cd, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun Jul 12 20:10:00 CST 2015, time=2015-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32384, encodeId=d61d32384ef, content=内容太短了, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01621631568, createdName=飞翔9899, createdTime=Sat Jul 11 21:48:00 CST 2015, time=2015-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370526, encodeId=046813e0526e3, content=<a href='/topic/show?id=00505450e5f' target=_blank style='color:#2F92EE;'>#手术部位感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54507, encryptionId=00505450e5f, topicName=手术部位感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cce318, createdName=wleon8895, createdTime=Sat Jul 11 02:53:00 CST 2015, time=2015-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32269, encodeId=ccf53226906, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a6a1604604, createdName=Gsurgeon, createdTime=Fri Jul 10 17:37:00 CST 2015, time=2015-07-10, status=1, ipAttribution=)]
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