Effects of controlled perioperative antimicrobial prophylaxis on infectious outcomes in pediatric cardiac surgery
Effects of controlled perioperative antimicrobial prophylaxis on infectious outcomes in pediatric cardiac surgery
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DOI：
10.1097/01.ccm.0000269027.50834.fe
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发表时间：
2007-07-01
影响因子：
8.8
通讯作者：
Fujita, Naohisa
中科院分区：
文献类型：
--
作者：
Kato, Yuko;Shime, Nobuaki;Fujita, Naohisa
目标。旨在检查小儿心脏手术中预防性使用抗菌药物方案的有效性。设计：对两组连续研究的患者进行非随机比较。地点：大学医院的儿科重症监护病房。患者：接受过心脏手术的婴儿和 < 18 岁儿童。干预措施：预防性抗菌药物限制在术后 < 48 小时内，以及耐甲氧西林葡萄球菌高风险的患者金黄色葡萄球菌，强烈建议使用糖肽。测量和主要结果：前 21 个月内 189 名患者（对照组）未进行干预，而在接下来的 18 个月内，185 名患者（干预组）进行了干预。在干预组中，建议术后 48 小时内停止预防。结果，干预组中抗菌药物的平均使用时间为 4 天（范围 2-14），明显短于对照组的 7 天（3-35）。这与术后感染频率较低（包括手术部位感染）的趋势相关，并且与对照组（17%）相比，干预组（8%）的抗菌治疗成本显着降低，新获得的鼻腔抗生素耐药病原体定植率显着降低。 1 由于在干预组中，糖肽被强烈推荐用于耐甲氧西林金黄色葡萄球菌高风险患者，因此干预组的手术部位感染频率（0% vs. 18%）和所有感染频率（11% vs. 39%）均显着低于对照组。结论：限制预防性抗菌药物的持续时间具有成本效益，并且在不增加术后感染频率的情况下降低了获得耐药病原体的风险。在正确选择的耐甲氧西林金黄色葡萄球菌感染高风险患者中使用糖肽可以降低术后感染的风险。
Objectives. To examine the efficacy of a protocol for the prophylactic use of antimicrobials in pediatric cardiac surgery.Design: Nonrandomized comparison of two groups of patients studied sequentially.Setting: Pediatric intensive care unit of university hospital.Patients: Infants and children < 18 yrs of age who had undergone cardiac surgery.Interventions: Limitation of prophylactic antimicrobials to < 48 hrs after operation and, in patients at high risk of methicillin-resistant Staphylococcus aureus, strong recommendation to use glycopeptides.Measurements and Main Results: No intervention was applied in 189 patients (control group) during the first 21 months, whereas the intervention was applied in 185 patients (intervention group) during the next 18 months. In the intervention group, prophylaxis was recommended to be discontinued < 48 hrs postoperatively. As a result, antimicrobials were administered for a median of 4 days (range 2-14) in the intervention group, significantly shorter than 7 days (3-35) in controls. This was associated with a trend toward a lower frequency of postoperative infections, including at the surgical site, and with significantly lower costs of antimicrobial therapy and a significantly lower rate of newly acquired nasal colonization with antibiotic-resistant pathogens in the intervention group (8%) than in controls (17%). 1 Since, in the intervention group, glycopeptides were strongly recommended for patients at high risk of methicillin-resistant S. aureus, the frequency of surgical-site infections (0% vs. 18%) and the frequency of all infections (11% vs. 39%) were significantly lower in the intervention group than in the control group.Conclusions: Limiting the duration of prophylactic antimicrobials was cost-effective and reduced the risk of acquiring resistant pathogens without increasing the frequency of postoperative infections. The use of glycopeptides in properly selected patients at high risk of methicillin-resistant S. aureus infection can lower the risk of postoperative infections.