Antibiotics for Groin Hernia Repair According to Evidence-Based Guidelines: Time for Action in Ghana.

Antibiotics for Groin Hernia Repair According to Evidence-Based Guidelines: Time for Action in Ghana.
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根据循证指南使用抗生素修复腹股沟疝气:加纳采取行动的时间到了。

DOI:
10.1016/j.jss.2019.01.040
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发表时间:
2019
期刊:
The Journal of surgical research
影响因子:
--
通讯作者:
Mock,Charles
Mock,Charles
中科院分区:
--
文献类型:
--
作者:
Gyedu,Adam;Katz,Micah;Agbedinu,Kwabena;Donkor,Peter;Mock,Charles

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腹股沟疝修补术(GHR)虽然被归类为清洁手术,但其手术部位感染率不同。我们评估的做法,在加纳的外科医生对抗生素的使用GHR相比,以证据为基础的国际指南(EBIG)。MethodsWe采访了加纳大学的医生和外科医生(GCPS),从成立(2003年)到2016年,关于他们使用抗生素的GHR培训的外科医生。我们定义了在GHR的抗生素使用中始终遵循EBIG的结局变量。Logistic回归被用来检查howa prioriselected协变量促成outcome. Results八十二117外科医生报告执行/监督每周至少一个GHR。他们平均每周执行/监督五次GHR。32例(40%)报告使用补片治疗至少50%的GHR。对于原发性GHR,75%的外科医生根据EBIG使用抗生素,而对于仅使用补片的GHR,45%的外科医生使用抗生素。持续遵循EBIG的预测因素是每周进行GHR的次数增加(校正比值比1.44,95% CI 1.07-1.96)和临床工作时间增加(校正比值比0.95,95% CI 0.91-0.99)。多年的实践,因为GCPS毕业,每周进行的总操作,和医院的实践水平是没有预测的outcome variable. ConclusionsTwo三分之二的加纳外科医生接受采访,并不一致的管理抗生素GHR每EBIG,提高需要改善获得循证医学信息的整体指导实践。在加纳和其他中低收入国家,确定当地手术部位感染率以指导GHR的抗生素使用将是有用的。
BackgroudGroin hernia repairs (GHR), though classified as clean surgeries, are associated with varying rates of surgical site infections. We assessed the practices of surgeons in Ghana regarding antibiotic use for GHR in comparison to evidence-based international guidelines (EBIG).MethodsWe interviewed surgeons trained by the Ghana College of Physicians and Surgeons (GCPS), from inception (2003) through 2016, about their use of antibiotics for GHR. We defined the outcome variable of consistently following EBIG in antibiotics use for GHR. Logistic regression was used to examine howa prioriselected covariates contributed to the outcome.ResultsEighty-two of 117 surgeons reported performing/supervising at least one GHR per week. They performed/supervised a mean of five GHR per week. Thirty-two (40%) reported using mesh for at least 50% of GHR. For primary GHR, 75% of surgeons administered antibiotics according to EBIG, whereas for GHR with mesh only, 45% did so. Predictors of consistently following EBIG were increasing number of GHR performed per week (adjusted odds ratio 1.44, 95% CI 1.07-1.96) and increasing time spent for clinical work (adjusted odds ratio 0.95, 95% CI 0.91-0.99). Years of practice since GCPS graduation, total operations performed per week, and hospital level of practice were not predictive of the outcome variable.ConclusionsTwo-thirds of Ghanaian surgeons interviewed do not consistently administer antibiotics for GHR per EBIG, raising the need to improve access to evidence-based medical information overall to guide practice. Determining local surgical site infections rates to guide antibiotic use in GHR will be useful in Ghana and other LMICs.
加纳北部的腹股沟疝气手术——波兰外科医生在塔马利的人道主义使命。
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