~Teachingcenter的醫學筆記~

減少手術傷口感染的方法-血糖控制 (glucose control)
= 術後的頭兩天，血糖應控制在200 mg/dL以下(尤其是心血管手術的病人)
= 尤其是空腹血糖(飯前早上6點)應控制在200 mg/dL
關於血糖的控制標準和腎臟的關係，可以參考：
https://teachingcenter1.pixnet.net/blog/post/353607746

 

減少手術傷口感染的方法-避免剃毛 (no hair removal)
= 除非是嚴重砂石汙染的傷口，常規手術現在已不建議術前剃毛
= 若有剃毛之必要性，不可使用刮鬍刀，應使用電動剃刀或化學脫毛膏，以避免皮表出現肉眼不可見的小傷口，使術後感染風險上升

 

減少手術傷口感染的方法-維持體溫 (normothermia)
= 術後離開刀房後的第一個小時，建議體溫維持在攝氏36~38度之間(尤其是大腸直腸手術的病人)

 

預防性抗生素的使用(prophylatic antibiotic use)
= 預防性抗生素應於下刀前的1小時內給予
※若為vancomycin or fluoroquinolone類藥物，則為2小時
= 預防性抗生素應於術後24小時內停用
※若為心臟、主動脈手術，可於48小時內停用
= 當病人對beta-lactam類抗生素(penicillin or cephalosporin)過敏時，可以使用clindamycin
= 若骨科、心臟血管手術的病人，對beta-lactam類抗生素(penicillin or cephalosporin)過敏時，可以使用vancomycin

 

經驗性抗生素的使用(antibacterial agents for empirical use)
= Antipseudomonoal
--- Piperacillin-tazobactam
--- Cefepime, ceftazidime
--- Imipenem-cilastatin, meropenem, doripenem
--- (?) Ciprofloxacin, levofloxacin (取決於感染區域的感受性)
--- Aminoglycosides
--- Polymyxins (polymixin B, colistin [polymyxin E])
= Anti- Gram-positive
--- Penicillin (ampicillin, oxacillin)
--- Cephalosporin (cefazolin, ceftriaxone)
--- Glycopepetide (vancomycin, teicoplanin)
--- Lipopeptide (daptomycin)
--- Fluoroquinolones
--- Oxazolidinone (linezolid)
--- Tigecycline
= Anti- Gram-negative
--- 3^rd generation cephalosporin
--- Carbapenems
--- Fluoroquinolones
--- Tigecycline
--- Monobactam
--- Polymyxins
= Antianaerobic
--- Metronidazole
--- Carbapenems
--- Beta-lactam + beta-lactamase inhibitor combination
--- Tigecycline
= Anti-MRSA
--- Ceftaroline
--- Daptomycin (對於MRSA肺炎的效果有限)
--- Minocycline (僅可口服使用)
--- Linezolid
--- Teicoplanin
--- Tigecyclin (孕婦或小於八歲之兒童不建議使用)
--- Vancomycin

 

From Sabiston Textbook of Surgery – The Biological Basis of Modern Surgical Practice 19^th edition, p246, 255, 285

 

Criteria for Defining a Surgical Site Infection
= Superficail Incisional
--- Infection less than 30 days after surgery
--- Involves skin and subcutaneous tissue only
--- Defining by one of the following:
…..a. Purulent drainage
…..b. Symptoms of erythema, pain and local edema
= Deep Incisional
--- Infection less than 30 days after surgery with no implant and soft tissue involvement
--- Infection less than 1 year after surgery with an implant; involves deep soft tissues (fascia and muscle)
--- Defining by one of the following:
…..a. Purulent drainage from the deep space but no extension into the organ space
…..b. Abscess found in the deep space on direct or radiologic examination or on re-operation
…..c. Symptoms of fever, pain, and tenderness leading to wound dehiscence or opening by a surgeon
= Organ Space
--- Infection less than 30 days after surgery with no implant
--- Infection less than 1 year after surgery with an implant; involves any part of the operation opened or manipulated
--- Defining by one of the following:
…..a. Purulent drainage from the drain placed in the organ space
…..b. Cultured organisms from material aspirated from the organ space
…..c. Abscess found on direct or radiologic examination or during re-operation
 

From Mangram AJ, Horan TC, Pearson ML, et al.: Guideline for prevention of surgical site infection. Infect Control Hosp Epidermiol 20:252, 1999.