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ObjectiveSurgical site infection (SSI)is a type of common hospital-acquired wounds. The purpose of this study is to understand its clinical characteristics and prognosis in order to provide evidence for taking appropriate measures.Methods132 wound patients who met the diagnostic criteria of surgical site infection in the wound care center in recent 3 years were enrolled. The patients were treated locally with nanosilver dressing combined with red light and infrared ray. Individualized nutritional recipes and activity prescriptions were given, and the skin was showered every other day to heal or last 2 months.Observation indicators: demographics and wound characteristics; changes of area and depth after14 days intervention; the posi-tive rate of bacteria before and after the intervention, and healing rate and healing time of 2 months were analyzed and compared.ResultsA total of 132 cases of SSI(52.27% superficial and 47.73% deep ) was identified. The average age was 48.33±16.90 years. The average age and gender of the two groups were similar (P>0.05).Peri-wound skin is contaminated in all cases. The mean onset time of SSIs was 19.82±5.64 days, and the median onset time was 20 days. The onset time and duration of deep SSIs were longer than that of superficial SSIs (P0.05), and the depth of deep SSIs was deeper than that of superficial SSIs (P<0.05).The positive rate of bacterial culture inthe deep SSI group (79.31%) was higher than that of the superficial SSI group (59.46%) (P<0.05). After 14 days treatment, the area was smaller, the depth was lower (P<0.05), and the positive rate of bacteria was significantly decreased in the two groups (P<0.05). The healing rate ofsuperficial SSI group (84.06%) was higher than that of deep SSI group (66.67%) (P<0.05) in two months, and the healing time of superficial SSI group was significantly shortened (35.46<11.12 days vs 41.08<11.33 days, P<0.05). Logistic regression analysis showed that negative bacterial culture before intervention increased the healing index (OR=0.190). Long-term use of antibiotics did not promote healing (OR=0.343).ConclusionSuperficial and deep SSIs are common types of SSIs. Gender and age are similar, and skin contamination may play a role in the development of SSI,which needs attention. Local and systemic interventions can effectively improve wound healing. Negative bacterial culture and proper use of antibiotics can improve the healingprobability.
RESUMO
Objective Few studies have paid attention to time-zero renal biopsy in living kidney transplantation so far. This article aimed to investigate the risk factors of latent pathologic changes in living donors by time-zero renal biopsy (TO-RBx) and the predictive value in the allograft function of recipients early after living kidney transplantation.Methods We retrospectively analysed the clinical data of 89 renal transplant recipients and living donors who received TO-RBx at Nanjing General Hospital from January 2008 to December 2016. According to the 2007 Banff criteria, the common pathologic changes in living donors such as latent glomeruloscerosis (GS), tubular atrophy (CT), interstitial fibrosis (CI), arteriolar hyaline thickening (AH) and vascular fibrous intimal thickening (CV) were scored. To analyze the influencing factors for different pathological changes and evaluate its predictive value in the allograft function of recipients in 1, 3, 6 months after living renal transplantation.Results Of all the TO-RBx specimens, 23 cases (25.84%) with GS (21 were mild change, 1 was moderate change and 1 was severe change), 33 cases (37.08%) with CT/CI changes (30 were mild change and 3 were moderate change) and 37 cases (41.57%) with AH/CV changes (36 were mild change and 1 was moderate change). GS was related to the donor age (P=0.042); CT/CI changes were related to donor age, gender and systolic pressure (P=0.019；0.006；0.01); arterial changes were related to donor gender and blood triglyceride level (P=0.029；0.049). Within 3 and 6 months after living donor renal transplantation, the eGFR of renal transplant recipients with GS lesions \[(65.96±17.17), (69.52±19.1)mL/min·1.73m2\] were significantly lower than the groups without lesions \[(76.91±18.98), (79.52±18.91)mL/min·1.73m2\] (P＜0.05).Conclusion Time-zero renal biopsy has significance in terms of predicting the allograft function in 6 months after transplantation. It can guide the formulation and adjustment of postoperative immunosuppressive regimens for recipients. Besides, it can also detect the latent pathologic changes in living donors and is one of the important evidence for establishing a personalized follow-up plan for donors after surgery. This method is practical in clinical.