Faktori rizika za nastanak infekcija operativnog mesta nakon primarno čistih ortopedskih hirurških zahvata

Abstract

Infekcije operativnog mesta (IOM) i danas predstavljaju značajne neželjene postoperativne događaje, posebno nakon artroplastika kuka i kolena. Ciljevi ove studije bili su da se odredi incidencija IOM kod pacijenata kojima su urađene artroplastike kuka i kolena, faktori rizika (FR) za njihov nastanak, prouzrokovači IOM i njihova rezistencija na određene antimikrobne lekove, primenjena antimikrobna profilaksa i kvalitet života operisanih pacijenata. Prospektivna kohortna studija sprovedena je u periodu maj 2016-april 2018. god. na Klinici za ortopedsku hirurgiju i traumatologiju, Kliničkog centra Srbije. U studiju su uključeni pacijenti stariji od 18 god. i podeljeni u 4 kohorte: pacijenti sa totalnom artroplastikom kuka, pacijenti sa totalnom artroplastikom kolena, pacijenti sa parcijalnom artroplastikom kuka i pacijenti sa parcijalnom artroplastikom kolena. Primarni ishodi studije bili su određivanje IOM do 30. i do 365. dana nakon urađene artroplastike. Kumulativna incidencija IOM do 30 dana nakon operacije bila je 5,4% nakon totalnih, a 2,3% nakon parcijalnih artroplastika kuka i 4,8% nakon totalnih artroplastika kolena. Nakon parcijalnih artroplastika kolena nisu registrovane IOM. Nezavisni FR za nastanak IOM kod totalnih artroplastika kuka bili su: ASA skor > 2 (p=0,015), pušenje (0,014) i periferna vaskularna bolest (<0,001), NHSN i Čarlson indeksi, a kod parcijalnih artroplastika kuka: duža preoperativna hospitalizacija (0,013), periferna vaskularna bolest (0,005), vreme preoperativnog brijanja u satima (0,010), dok je kraće nošenje drena nakon operacije bilo protektivni faktor. FR kod totalnih artroplastika kolena bila je periferna vaskularna bolest (0,037). Najčešće izolovani prouzrokovači IOM kod totalnih artroplastika bili su koagulaza negativni Staphylococcus (58% rezistentan na meticilin), a kod parcijalnih artroplastika Acinetobacter spp. (83% rezistentno na karbapeneme). Antimikrobnu profilaksu nije primilo samo 1,3%. Kvalitet života pacijenata godinu dana nakon operacije bio je bolji u većini domena prema SF36 i EQ-5D upitnicima kod pacijenata koji nisu imali IOM. Rezultati ove studije ukazuju na nešto više incidencije IOM nakon artroplastika kuka i kolena nego u drugim zemljama. Sagledavanje FR za nastanak IOM omogućiće preduzimanje adekvatnih mera prevencije, što bi trebalo da dovede i do poboljšanja kvalitea života operisanih pacijenata.

Surgical site infections (SSI) still represent significant postoperative adverse events, especially after hip and knee arthroplasty. The objectives of this study were to determine the incidence of SSI in patients with hip and knee arthroplasty, risk factors (RF) for their occurrence, microorganisms which cause SSIs and their resistance to certain antimicrobial drugs, applied surgical antibiotic prophylaxis and quality of life of operated patients. The prospective cohort study was conducted in the period May 2016-April 2018. at the Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Serbia. The study included patients older than 18 years of age.who were divided into 4 cohorts: patients with total hip arthroplasty, patients with total knee arthroplasty, patients with partial hip arthroplasty, and patients with partial knee arthroplasty. The primary outcomes of the study were the determination off SSI occurrence in 30 days and 1 year after hip and knee arthroplasty. The cumulative incidence of SSI up to 30 days after surgery was 5.4% after total hip arthroplasty and 4.8% after total knee arthroplasty. None SSI were registered after partial knee artrhroplasty. Independent FRs for the development of SSI after total hip arthroplasty were: ASA score>2 (p=0.015), smoking (0.014) and peripheral vascular disease (<0.001), NHSN risk index and Charlson comorbidity index. After partial hip arthroplasty RFs were: prolonged preoperative hospitalization, peripheral vascular disease (0.005), preoperative shaving time in hours (0.010), while shorter time of carrying wound drain was a protective factor. RF after total knee arthroplasty was a peripheral vascular disease (0.037). The most commonly isolated microorganisms after total arthroplasties were coagulase-negative Staphylococcus (58% methicillin-resistant), after partial arthroplasties it was Acinetobacter spp. (83% resistant to carbapenems). Only 1,3% did not receive antimicrobial prophylaxis. Patient quality of life one year after surgery was better in most domains according to the SF36 and EQ-5D questionnaires in patients who did not develop SSIs. The results of this study indicate a slightly higher incidence of SSI after hip and knee arthroplasty than in other countries. Deatiled consideration of the RF for the SSI development will enabled the implementation of adequate preventive measures, which could lead to siignificant improvement of the quality of life of the operated patients.