ACOG Practice Bulletin No. 199: Use of Prophylactic Antibiotics in Labor and Delivery.
ACOG Practice Bulletin No. 199: Use of Prophylactic Antibiotics in Labor and Delivery.
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DOI：
10.1097/aog.0000000000002833
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发表时间：
2018-09-01
影响因子：
7.2
通讯作者：
中科院分区：
文献类型：
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作者：
在产前、产中和产后使用抗生素预防感染与使用抗生素治疗已确定的感染是不同的。多年来，预防性抗生素的使用被认为几乎没有不良后果。对常见细菌耐药菌株的出现以及毒力增加的菌株的出现的担忧，导致了对抗生素使用的更严格的审查，特别是在医院环境中。人们对耐药细菌感染对新生儿的潜在不利影响的认识一直在增长。人们的注意力集中在分娩方式或早期抗生素暴露对新生儿口腔和肠道微生物群的影响上，这是免疫发育所必需的。最后，在使用和选择避孕药时，成本是一个考虑因素。本实践报告的目的是对经常开预防性抗生素的临床情况进行回顾，并权衡支持在这些情况下使用抗生素的证据。本实践公告的更新反映了有限的变化，以澄清和提供关于手术中抗菌预防和手术部位感染预防的最新共识指南中的建议的额外信息。以下与剖腹产相关的做法包括：术前皮肤和阴道清洁，头孢唑林抗生素预防按体重计算的剂量，附加阿奇霉素抗生素预防，青霉素过敏妇女的抗生素选择和剂量。
The use of antibiotics to prevent infections during the antepartum, intrapartum, and postpartum periods is different than the use of antibiotics to treat established infections. For many years, the use of prophylactic antibiotics was thought to have few adverse consequences. Concerns about the emergence of resistant strains of common bacteria, in addition to the emergence of strains with increased virulence, have resulted in increased scrutiny of the use of antibiotics, particularly in the hospital setting. Awareness of the potential adverse effects of resistant bacterial infections on neonates has been growing. Attention has been focused on the effect of mode of delivery or early antibiotic exposure on the neonatal oral and gut microbiome, which is essential for immune development. Finally, cost is a consideration in the use and choice of prophylactic agents. The purpose of this Practice Bulletin is to present a review of clinical situations in which prophylactic antibiotics are frequently prescribed and to weigh the evidence that supports the use of antibiotics in these scenarios. This Practice Bulletin is updated to reflect a limited change to clarify and provide additional information on recommendations from recent consensus guidelines for antimicrobial prophylaxis in surgery and the prevention of surgical site infection. The following practices related to cesarean delivery include preoperative skin and vaginal cleansing, weight-based dosage for cefazolin antibiotic prophylaxis, the addition of adjunctive azithromycin antibiotic prophylaxis, and antibiotic selection and dosage for women with a penicillin allergy.