Med Bull Sisli Etfal Hosp. 2019; 53(2): 132-136 | DOI: 10.14744/SEMB.2019.46693

Platelet Indices as the Predictor of Antibiotics Response in Surgical Wound Infections Following Total Abdominal Hysterectomy

Aysu Akça¹, Gulseren Yilmaz², Nadiye Köroðlu^1
1Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Hospital, Istanbul, Turkey
²Department of Anesthesiology and Reanimation, Kanuni Sultan Suleyman Hospital, Istanbul, Turkey

Objectives: The mean platelet volume (MPV) and the MPV-to-platelet (PLT) count ratio have long been reported as inflammation markers. In this study, we aimed to investigate the predictive value of the MPV and the MPV-to-PLT ratio on surgical wound healing in patients who underwent abdominal hysterectomy and experienced infections at the surgical site following surgery, despite adequate antimicrobial treatment.
Methods: A total of 100 patients who encountered surgical wound infection (SWI) after abdominal hysterectomy were enrolled retrospectively. Samples for complete blood count were drawn the day before the operation. All patients received preoperative and postoperative antibiotic prophylaxis and proper antimicrobial treatment following the SWI development. Patients’ condition resolved after standard care and antimicrobial agents were classified as the standard care group. Others, in whom an improvement despite the standard care was not observed, underwent delayed primary closure and were classified as the delayed primary closure group.
Results: The PLT count was decreased (319.5±66 103/µL vs. 392±121 103/µL; p<0.05), MPV(9.2±1.3 fL vs. 8.2±1.5 fL; p<0.05), and the MPV-to-PLT ratio (0.030±0.006 vs. 0.024±0.014; p<0.05) was increased in the delayed primary closure group compared to the standard care group. A receiver operating characteristic curve analysis was performed to determine the predictive value of these parameters on the response to standard care measures providing 8.28fL as a cut-off value for MPV (AUC=0.647, 72% sensitivity and 52% specificity) and 0.025 as a cut-off value for the MPV-to-PLT ratio (AUC=0.750, 75% sensitivity and 67% specificity) for predicting nonresponsiveness.
Conclusion: An increased preoperative MPV and the MPV-to-PLT ratio may predict poor wound healing following total abdominal hysterectomy.

Keywords: Delayed primary closure, mean platelet volume, platelet count; surgical wound infection; total abdominal hysterectomy.

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Trombosit Ýndeksleri Total Abdominal Histerektomi Sonrasý Yara Yeri Enfeksiyonu Geliþen Hastalarda Antibiyotiklere Yanýtý Öngörebilir mi?

Aysu Akça¹, Gulseren Yilmaz², Nadiye Köroðlu^1
1Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Hospital, Istanbul, Turkey
²Department of Anesthesiology and Reanimation, Kanuni Sultan Suleyman Hospital, Istanbul, Turkey

Amaç: Ortalama trombosit hacmi (OTH) ve OTH/Trombosit sayýsý oraný inflamasyonun belirteçleri olarak bilinmektedirler. Bu çalýþmada cerrahi histerektomi uygulanan ve uygun antibiyotik tedavisine raðmen yara yeri enfeksiyonu geliþen hastalarda OTH ve OTH/Trombosit oranýnýn yara iyileþmesi için bir belirteç olup olmadýðýný araþtýrmayý amaçladýk.
Yöntem: Abdominal histerektomi (TAH) sonrasý yara yeri enfeksiyonu geliþen 100 hasta geriye dönük olarak çalýþmaya dahil edildi. Tam kan sayýmý için kan örnekleri cerrahiden önceki gün alýndý. Tüm hastalar cerrahi öncesi ve sonrasý antibiyotik profilaksisi ve yara yeri enfeksiyonu için uygun antibiyotik aldý. Standart bakým ve antimikrobiyal tedavi ile iyileþen hastalar standart tedavi grubu olarak adlandýrýldý. Standart bakýma raðmen geliþme olmayan ve gecikmiþ primer kapama planlanan hastalar gecikmiþ primer kapama grubu olarak adlandýrýldý.
Bulgular: Gecikmiþ primer kapama grubunda standart tedavi grubuna göre trombosit sayýlarý daha azdý (319.5±66 103/µL’ ye karþý 392±121 103/µL; p< 0.05) ancak OTH (9.2±1.3 fL’ye karþý 8.2±1.5 fL; p< 0.05) ve OTH/Trombosit oraný (0.030 ± 0.006’ ye karþý 0.024±0.014; p< 0.05) ve anlamlý þekilde yüksekti. ROC eðrisi analizi standart tedaviye yanýtsýzlýðý belirlemede OTH için 8.28 fL deðerini (Eðri altýndaki alan: 0.647, 72% sensitivite ve 52% spesifisite), OTH/Trombosit oraný için 0.025 oranýný (Eðri altýndaki alan: 0.750, 75% sensitivite ve 67% spesifisite) kesim deðeri olarak belirledi.
Sonuç: Yüksek preoperatif OTH ve OTH/Trombosit oraný TAH sonrasý kötü yara iyileþmesi için belirteç olabilir.

Anahtar Kelimeler: Total abdominal histerektomi, cerrahi yara enfeksiyonu, gecikmiþ primer kapama, ortalama trombosit hacmi, trombosit sayýsý

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