An observational cohort study on the effects of extended postoperative antibiotic prophylaxis on surgical-site infections in low- and middle-income countries.
An observational cohort study on the effects of extended postoperative antibiotic prophylaxis on surgical-site infections in low- and middle-income countries.
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DOI：
10.1093/bjs/znad438
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发表时间：
2024-01-03
期刊：
影响因子：
--
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中科院分区：
文献类型：
--
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在世界范围内，大约六分之一的住院抗生素处方用于手术感染预防，包括术后预防。世卫组织建议不要在术后长期使用抗生素，以防止手术部位感染。然而，在许多低收入和中等收入国家，术后抗生素预防是常见的，因为人们认为它可以防止手术部位感染，并且建议不使用抗生素的数据主要来自高收入国家。本研究的目的是描述在低收入和中等收入国家医院的术后抗生素处方模式和相关手术部位感染率。包括来自埃塞俄比亚、马达加斯加、印度和玻利维亚19家医院的I类和II类伤口手术患者。由训练有素的人员收集抗生素给药、适应证、手术部位感染、住院时间和围手术期感染预防标准的依从性数据。术后大于或等于24小时的抗生素预防与手术部位感染之间的关系通过改良的稳健泊松回归分析，控制患者和程序因素以及围手术期感染预防措施的遵守程度。在8714例患者中，92.9%的患者术后使用抗生素进行预防，27.7%的患者使用抗生素的时间大于或等于24小时。接受术后预防治疗大于或等于24小时的患者手术部位感染率并未降低(相对危险度1.09 (95% ci . 0.89 ~ 1.33)；P = 0.399)，但住院时间长1.4 d （P < 0.001）。术后延长抗生素并不能减少手术部位感染，但在资源有限的医疗保健系统中，普遍使用抗生素与更长的住院时间有关。随着抗菌素耐药性的威胁日益严重，在低收入和中等收入国家实施抗菌素管理规划的外科行动至关重要。这项队列研究评估了低收入和中等收入国家的19家医院术后抗生素预防是否降低了手术部位感染的风险，在这些国家，术后预防很常见。术后给予大于或等于24小时的预防与手术部位感染的风险降低无关。
Worldwide, approximately one in six inpatient antibiotic prescriptions are for surgical-infection prophylaxis, including postoperative prophylaxis. The WHO recommends against prolonged postoperative antibiotics to prevent surgical-site infection. However, in many low- and middle-income countries, postoperative antibiotic prophylaxis is common due to perceptions that it protects against surgical-site infection and data informing recommendations against antibiotic administration are largely derived from high-income countries. The aim of this study was to describe postoperative antibiotic-prescribing patterns and related surgical-site infection rates in hospitals in low- and middle-income countries. Patients from 19 hospitals in Ethiopia, Madagascar, India, and Bolivia with wound class I and II operations were included. Data on antibiotic administration, indication, surgical-site infection, length of hospital stay, and adherence to perioperative infection-prevention standards were collected by trained personnel. The association between postoperative antibiotic prophylaxis for greater than or equal to 24 h and surgical-site infection was analysed via modified robust Poisson regression, controlling for patient and procedural factors and degree of adherence to perioperative infection-prevention practices. Of 8714 patients, 92.9% received antibiotics for prophylaxis after surgery and 27.7% received antibiotics for greater than or equal to 24 h. Patients receiving postoperative prophylaxis for greater than or equal to 24 h did not have lower surgical-site infection rates (Relative risk 1.09 (95% c.i. 0.89 to 1.33); P = 0.399), but the length of hospital stay was 1.4 days longer (P < 0.001). Prolonged postoperative antibiotics did not reduce surgical-site infection, but pervasive use was associated with a longer length of hospital stay, in resource-limited healthcare systems. With the growing threat of antimicrobial resistance, surgical initiatives to implement antimicrobial stewardship programmes in low- and middle-income countries are critical. This cohort study evaluated whether postoperative antibiotic prophylaxis decreased the risk of surgical-site infections in 19 hospitals in low- and middle-income countries, where postoperative prophylaxis is common. Administering postoperative prophylaxis for greater than or equal to 24 h was not associated with a lower risk of surgical-site infection.
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影响因子：
1.1
作者：
Ampaire L;Muhindo A;Orikiriza P;Mwanga-Amumpaire J;Bebell L;Boum Y
通讯作者：
Boum Y
肯尼亚锡卡医院改变外科抗生素预防的使用：采用间断时间序列设计的质量改进干预措施。
影响因子：
3.7
作者：
Aiken AM;Wanyoro AK;Mwangi J;Juma F;Mugoya IK;Scott JA
通讯作者：
Scott JA
影响因子：
34.3
作者：
Versporten, Ann;Zarb, Peter;Goossens, Herman
通讯作者：
Goossens, Herman
DOI：
10.1016/s0140-6736(21)02724-0
发表时间：
2022-02-12
期刊：
Lancet (London, England)
影响因子：
--
作者：
Antimicrobial Resistance Collaborators
通讯作者：
Antimicrobial Resistance Collaborators
影响因子：
5.5
作者：
Belachew SA;Hall L;Selvey LA
通讯作者：
Selvey LA