Systematic review of interventions on antibiotic prophylaxis in surgery in Chinese hospitals during 2000-2012.
Systematic review of interventions on antibiotic prophylaxis in surgery in Chinese hospitals during 2000-2012.
复制标题
DOI：
10.1111/jebm.12048
复制
发表时间：
2013-08-01
影响因子：
--
通讯作者：
Sun, Jing
中科院分区：
文献类型：
--
作者：
Sun, Jing
目的：系统回顾2000 - 2012年我国医院清洁手术或清洁污染手术中预防性应用抗生素的干预研究。方法：通过检索CNKI、CBM、VIP、PubMed（MEDLINE）、WHO数据库和中国卫生部官方网站，识别出已发表的同行评议文章、未发表的文献和报告以及灰色文献，结果：共检索到82篇文献。主要采取的干预措施有：中央法规和指南的传播和本地化;临床药师的参与;技术、行政和管理策略。除一项研究外，所有研究都声称干预措施有效。观察到非适应症清洁手术的影响有限。在国际商定的准则与干预后声称的最佳业绩之间仍然存在巨大差距。以下是更有效的干预措施的关键：承认，接受和执行规则，条例和指导方针的战略;干预的持久性和强度;卫生信息系统;消除卫生系统的不正当激励措施;医患关系;公共教育;以及获得公正的药物信息。82项研究中共有4项是有对照的前后研究;所有其他研究都是无对照的简单前后研究。简单测量结果指标作为干预前后组的平均值以及干预组之间的变化无法区分真实的干预效果与混杂因素，也无法调整潜在的趋势。结论：2000-2012年中国医院外科抗生素预防干预带来的积极效果有限。中国的情况与国际公认的标准之间仍然存在巨大差距。需要更先进的研究方法，以更好地记录最有效干预措施的证据。
OBJECTIVE: To systematically review intervention studies on antibiotic prophylaxis in clean or clean-contaminated surgery in Chinese hospitals from 2000 to 2012.METHODS: Published peer reviewed articles, unpublished documents and reports, and gray literature were identified through searching CNKI, CBM, VIP, PubMed (MEDLINE), WHO database, and the official websites of the Ministry of Health of China, provincial health authorities and medical university internal publications.RESULTS: Eighty-two studies were identified. Circulation and localization of central rules, regulations and guidelines; clinical pharmacists' involvement; technical, administrative, and managerial strategies were the mostly adopted interventions. Except one study, all claimed effectiveness of interventions. Limited effects were observed for non-indicated clean surgery. Huge gaps still existed between the international agreed guidelines and the claimed best performance following interventions. The following were critical to have more effective interventions: recognition, acceptance, and enforcement strategies of rules, regulations, and guidelines; intervention persistence and intensity; health information system; removal of health system perverse incentives; patient-doctor relationship; public education; and access to unbiased medicines information. A total 4 of 82 studies were pre-post studies with control; all others were simple pre-post studies without control. Simple measurement of the outcome indicators as an average for pre-post intervention groups and changes in between failed to distinguish the real intervention effect from confounding factors, and failed to adjust underlying trends.CONCLUSIONS: Interventions on surgical antibiotic prophylaxis in Chinese hospitals during 2000-2012 brought limited positive effects. There are still huge gaps between the Chinese situation and internationally agreed standards. More advanced study methodologies are needed to have better documentation of evidence of the most effective interventions.