金黄色葡萄球菌在麻醉工作区域的传播，如果对用于手术预防的抗生素产生耐药性，则与手术部位感染的发生有更大的关联风险。
Transmission of Staphylococcus aureus in the anaesthesia work area has greater risk of association with development of surgical site infection when resistant to the prophylactic antibiotic administered for surgery.
机构信息
University of Iowa, Iowa City, IA, USA.
University of Iowa, Iowa City, IA, USA.
出版信息
J Hosp Infect. 2023 Apr;134:121-128. doi: 10.1016/j.jhin.2023.01.007. Epub 2023 Jan 21.
BACKGROUND
The extent to which the transmission of prophylactic-antibiotic-resistant bacteria from the anaesthesia work area increases the risk of surgical site infection (SSI) is unknown. It was hypothesized that the risk of SSI would increase progressively from no transmission to transmission of prophylactic-antibiotic-resistant isolates.
METHODS
This was a retrospective analysis of archival samples collected in two previously published studies with similar inclusion criteria and sample collection methodology (observational study 2009-2010 and randomized trial 2018-2019). Archival isolates were linked by barcode to all patient demographic and procedural information, including the prophylactic antibiotic administered, transmission and development of SSI. For this study, all archival isolates underwent prophylactic antibiotic susceptibility testing, and the ordered association of transmission of Staphylococcus aureus (no transmission, transmission of prophylactic-antibiotic-susceptible isolates and transmission of prophylactic-antibiotic-resistant isolates) with SSI was assessed.
RESULTS
The risk of development of SSI was 2% (8/406) without S. aureus transmission, 11% (9/84) with transmission of S. aureus isolates that were susceptible to the prophylactic antibiotic used, and 18% (4/22) with transmission of prophylactic-antibiotic-resistant S. aureus isolates. The Cochrane-Armitage two-sided test for ordered association was P<0.0001. Treating these three groups as 0, 1 and 2, by exact logistic regression, the odds of SSI increased by 3.59 with each unit increase (95% confidence interval 1.92-6.64; P<0.0001).
CONCLUSIONS
Transmission of S. aureus in the anaesthesia work area reliably increases the risk of SSI, especially when the isolates are resistant to the prophylactic antibiotic administered.
背景
预防性使用抗生素耐药菌从麻醉工作区传播增加手术部位感染（SSI）的风险程度尚不清楚。假设 SSI 的风险会从无传播逐渐增加到预防性使用抗生素耐药菌的传播。
方法
这是对两项先前发表的研究中收集的存档样本进行的回顾性分析，这些研究具有相似的纳入标准和样本收集方法（2009-2010 年的观察性研究和 2018-2019 年的随机试验）。存档分离物通过条形码与所有患者的人口统计学和程序信息相关联，包括给予的预防性抗生素、传播和 SSI 的发展。在这项研究中，所有存档分离物均进行了预防性抗生素药敏测试，并评估了金黄色葡萄球菌（无传播、传播对预防性抗生素敏感的分离物和传播对预防性抗生素耐药的分离物）的传播与 SSI 的有序关联。
结果
无金黄色葡萄球菌传播时 SSI 的发展风险为 2%（8/406），传播对预防性抗生素敏感的金黄色葡萄球菌分离物时为 11%（9/84），传播对预防性抗生素耐药的金黄色葡萄球菌分离物时为 18%（4/22）。对于有序关联，Cochrane-Armitage 双侧检验 P<0.0001。将这三组分别视为 0、1 和 2，通过精确逻辑回归，SSI 的发生几率每增加一个单位增加 3.59（95%置信区间 1.92-6.64；P<0.0001）。
结论
金黄色葡萄球菌在麻醉工作区的传播可靠地增加了 SSI 的风险，尤其是当分离物对给予的预防性抗生素耐药时。
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