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Postoperative Wundinfektionen

Pathophysiologie, Risikofaktoren und präventive Konzepte

Postoperative wound infections

Pathophysiology, risk factors and preventive concepts

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Zusammenfassung

Postoperative Wundinfektionen sind nach Pneumonien und Harnwegsinfektionen die dritthäufigste nosokomiale Infektionsart in deutschen Akutkrankenhäusern. Sie führen zu gesteigerter Morbidität und Letalität, verlängertem Krankenhausaufenthalt und höheren Behandlungskosten. Zu den wichtigsten Risikofaktoren zählen der mikrobiologische Befund im Bereich der Hautinzision, eine nichtfristgerechte Antibiotikaprophylaxe, die Dauer der Operation, der Notfalleingriff, ein schlecht oder nichteingestellter Diabetes mellitus, maligne Grunderkrankung, chronischer Tabakabusus und hohes Lebensalter. Anästhesiologische Maßnahmen zur Vermeidung von Wundinfektionen umfassen die Aufrechterhaltung von Normothermie, eine adäquate Infusionstherapie, die strenge Indikationsstellung für allogene Bluttransfusionen und die rechtzeitige Antibiotikaprophylaxe. Die Blutglucosekonzentration sollte postoperativ im Bereich von 8,3–10 mmol/l (150–180 mg/dl) gehalten werden; niedrigere Werte sind mit einer erhöhten Komplikationsrate assoziiert. Die intra- und postoperative Hyperoxie mit 80%igem Sauerstoff hat sich nicht als wirksam zur Verhinderung von Wundinfektionen erwiesen. Eine Infiltration des Wundgebiets mit Lokalanästhetika zur postoperativen Schmerztherapie beeinträchtigt die Wundheilung nicht.

Abstract

Postoperative wound infections are the third most common type of nosocomial infection in German emergency hospitals after pneumonia and urinary infections. They are associated with increased morbidity and mortality, prolonged hospital stay and increased costs. The most important risk factors include the microbiological state of the skin surrounding the incision, delayed or premature prophylaxis with antibiotics, duration of surgery, emergency surgery, poorly controlled diabetes mellitus, malignant disease, smoking and advanced age. Anesthesiological measures to decrease the incidence of wound infections are maintaining normothermia, strict indications for allogenic blood transfusions and timely prophylaxis with antibiotics. Blood glucose concentrations should be kept in the range of 8.3–10 mmol/l (150–180 mg/dl) as lower values are associated with increased complications. Intraoperative and postoperative hyperoxia with 80% O2 has not been shown to effectively decrease wound infections. The application of local anesthetics into the surgical wound in clinically relevant doses for postoperative analgesia does not impair wound healing.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie und Intensivtherapie, Universitätsklinikum A.ö.R., Otto-von-Guericke-Universität, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    T. Hachenberg & M. Sentürk

  2. Klinik für Allgemeine, Viszeral- und Gefäßchirurgie, Universitätsklinikum A.ö.R., Otto-von-Guericke-Universität, Magdeburg, Deutschland

    O. Jannasch & H. Lippert

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  1. T. Hachenberg
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  2. M. Sentürk
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  3. O. Jannasch
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  4. H. Lippert
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Correspondence to T. Hachenberg.

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Hachenberg, T., Sentürk, M., Jannasch, O. et al. Postoperative Wundinfektionen. Anaesthesist 59, 851–868 (2010). https://doi.org/10.1007/s00101-010-1789-4

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