Prevention of surgical site infection via antibiotic administration according to guidelines after gynecological surgery
Prevention of surgical site infection via antibiotic administration according to guidelines after gynecological surgery
复制标题
DOI：
10.1111/jog.13714
复制
发表时间：
2018-09-01
影响因子：
1.6
通讯作者：
Fushimi, Kiyohide
中科院分区：
文献类型：
--
作者：
Toba, Mikayo;Moriwaki, Mutsuko;Fushimi, Kiyohide
目的根据日本化学治疗学会和日本感染病学会的指南，对手术部位感染（SSI）的抗菌预防进行了改进方法2016年4月至2017年3月，我们在优化的情况下进行剖宫产和开腹子宫切除术，并将结果与2014年4月至2016年3月期间未进行优化的手术结果进行了比较。我们测量了抗生素停药率、适当抗生素选择率、SSI发生率、抗生素治疗恢复率和发热发生率，以及术后住院时间和抗生素医疗费用，以评估抗生素预防的适当性和结局。SSI发生率无明显变化（0.74%vs0.0%，P = 0.36）。优化减少了抗生素的使用和子宫切除术的医疗费用（不伴淋巴结切除术的子宫切除术的中位数分别减少50%和78%）。然而，有没有改变的结果，关于SSI的发生率（5.7%比0.0%，P = 0.11和7.8%比9.5%，P = 0.77）。结论根据指南适当使用抗生素减少抗生素的剂量和医疗费用，但没有改变的结果，关于SSI的发生率。这些发现表明，根据指南实施给药方案将有助于降低抗生素药物成本，预防耐药菌和抗生素相关并发症。
AimWe modified the antimicrobial prophylaxis of surgical site infection (SSI) according to the guidelines of the Japanese Society of Chemotherapy and Japan Society of Infectious Diseases (hereinafter referred to as optimization) and measured outcomes.MethodsFrom April 2016 to March 2017, we performed cesarean section and open hysterectomy with optimization, and compared the outcome to that of surgery performed without optimization between April 2014 and March 2016. We measured the rates of antibiotic discontinuation, appropriate antibiotic selection, SSI incidence, resumption of antibiotic therapy and fever incidence, as well as the length of postoperative hospital stay and medical expenses for antibiotics to evaluate the appropriateness and outcomes of antibiotic prophylaxis.ResultsOptimization resulted in a change in the method of selecting antibiotics for cesarean section, but there was no change in SSI incidence rate (0.74% vs 0.0%, P = 0.36). Optimization reduced the use of antibiotics and medical expenses of hysterectomy (median reduction of 50% and 78% for hysterectomy without or with lymphadenectomy, respectively). However, there was no change in outcome regarding SSI incidence (5.7% vs 0.0%, P = 0.11 and 7.8% vs 9.5%, P = 0.77, respectively).ConclusionAppropriate use of antibiotics according to guidelines reduced antibiotic dose and medical expenses, but there was no change in outcome regarding SSI incidence rate. These findings suggested that implementation of dosing regimens according to the guidelines would be useful to reduce antibiotic medicine costs and prevent resistant bacteria and complications associated with antibiotics.