BACKGROUND:Antibiotic prophylaxis that covers enteric pathogens is essential in preventing surgical site infections (SSIs) after colorectal surgery. Current prophylaxis regimens do not cover extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). We aimed to determine whether the risk of SSI following colorectal surgery is higher in ESBL-PE carriers than in noncarriers. METHODS:We conducted a prospective cohort study of patients who underwent elective colorectal surgery in 3 hospitals in Israel, Switzerland, and Serbia between 2012 and 2017. We included patients who were aged ≥18 years, were screened for ESBL-PE carriage before surgery, received routine prophylaxis with a cephalosporin plus metronidazole, and did not have an infection at the time of surgery. The exposed group was composed of ESBL-PE-positive patients. The unexposed group was a random sample of ESBL-PE-negative patients. We collected data on patient and surgery characteristics and SSI outcomes. We fit logistic mixed effects models with study site as a random effect. RESULTS:A total of 3600 patients were screened for ESBL-PE; 13.8% were carriers SSIs occurred in 55/220 carriers (24.8%) and 49/440 noncarriers (11.1%, P < .001). In multivariable analysis, ESBL-PE carriage more than doubled the risk of SSI (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.50-3.71). Carriers had higher risk of deep SSI (OR, 2.25; 95% CI, 1.27-3.99). SSI caused by ESBL-PE occurred in 7.2% of carriers and 1.6% of noncarriers (OR, 4.23; 95% CI, 1.70-10.56). CONCLUSIONS:ESBL-PE carriers who receive cephalosporin-based prophylaxis are at increased risk of SSI following colorectal surgery.

译文

背景:涵盖肠道病原体的抗生素预防对于预防结直肠手术后的手术部位感染(SSI)至关重要。当前的预防方案并不涵盖产生广谱β-内酰胺酶的肠杆菌科(ESBL-PE)。我们旨在确定结直肠外科手术后SBL的风险是否在ESBL-PE携带者中比在非携带者中更高。
方法:我们对2012年至2017年之间在以色列,瑞士和塞尔维亚的3所医院接受了选择性结直肠手术的患者进行了一项前瞻性队列研究。我们纳入了年龄≥18岁的患者,这些患者在手术前接受了ESBL-PE支架筛查,接受了头孢菌素加甲硝唑的常规预防,并且在手术时没有感染。暴露组由ESBL-PE阳性患者组成。未暴露组是ESBL-PE阴性患者的随机样本。我们收集了有关患者和手术特征以及SSI结果的数据。我们将逻辑混合效应模型与研究地点拟合为随机效应。
结果:共筛查了3600名ESBL-PE患者。运营商SSI中有13.8%发生在55/220运营商中(24.8%)和49/440非运营商中(11.1%,P <.001)。在多变量分析中,ESBL-PE携带SSI的风险增加了一倍以上(几率[OR]为2.36; 95%置信区间[CI]为1.50-3.71)。承运商具有较高的深SSI风险(OR为2.25; 95%CI为1.27-3.99)。由ESBL-PE引起的SSI发生在7.2%的运营商和1.6%的非运营商中(OR为4.23; 95%CI为1.70-10.56)。
结论:接受基于头孢菌素的预防的ESBL-PE携带者在结直肠手术后罹患SSI的风险增加。

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