背景：
覆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。目前的预防方案不包括产超广谱β-内酰胺酶的肠杆菌科（ESBL-PE）。我们的目的是确定ESBL-PE携带者结直肠手术后SSI的风险是否高于非携带者。

方法：
我们对2012 - 2017年期间在以色列，瑞士和塞尔维亚的三家医院接受选择性结肠直肠手术的患者进行了一项前瞻性队列研究。我们纳入了18岁及以上的患者，在手术前进行了ESBL-PE运输筛查，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。暴露组是所有ESBL-PE阳性患者。未暴露组是ESBL-PE阴性患者的随机样本。我们收集了患者和手术特征以及SSI结果的数据。我们将后勤混合效应模型与研究地点作为随机效应。

结果：
共筛选了3600名患者的ESBL-PE; 13.8％为携带者（大肠杆菌，81.3％，其他ESBL-PE，18.7％）。我们分析了222个ESBL-PE携带者和440个非携带者。 SSI发生在55个携带者（24.8％）和49个非携带者（11.1％，P <0.001）。在多变量分析中，ESBL-PE携带的SSI风险增加了一倍以上（OR = 2.36, 95％CI：1.50-3.71）。携带者具有较高的SSI风险（OR = 2.25 95％CI：1.27-3.99）。ESBL-PE引起的SSI发生在7.2％的携带者和1.6％的非携带者（OR = 4.23,95％CI：1.70-10.56）。

结论：
接受基于头孢菌素预防的ESBL-PE携带者在结直肠手术后患SSI的风险增加。

BACKGROUND:
Antibiotic prophylaxis covering enteric pathogens is essential in preventing surgical site infection (SSI) 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 non-carriers.

METHODS:
We conducted a prospective cohort study of patients undergoing elective colorectal surgery in three hospitals in Israel, Switzerland, and Serbia between 2012-2017. We included patients who were 18 and older, 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 all 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 (E.coli, 81.3%, other ESBL-PE, 18.7 %). We analyzed 222 ESBL-PE carriers and 440 non-carriers. SSI occurred in 55 carriers (24.8%) and 49 non-carriers (11.1%, P<0.001). In multivariable analysis, ESBL-PE carriage more than doubled the risk of SSI (OR= 2.36, 95% 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 non-carriers (OR= 4.23, 95% CI: 1.70-10.56).

CONCLUSION:
ESBL-PE carriers who receive cephalosporin-based prophylaxis are at increased risk of SSI following colorectal surgery.

https://www.ncbi.nlm.nih.gov/pubmed/30204851