Use of antimicrobial prophylaxis for major surgery - Baseline results from The National Surgical Infection Prevention Project
Use of antimicrobial prophylaxis for major surgery - Baseline results from The National Surgical Infection Prevention Project
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DOI：
10.1001/archsurg.140.2.174
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发表时间：
2005-02-01
影响因子：
--
通讯作者：
Red, L
中科院分区：
文献类型：
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作者：
Bratzler, DW;Houck, PM;Red, L
假设：手术部位感染 (SSI) 是导致患者受伤、死亡和医疗费用的主要原因。尽管有证据表明抗菌药物可有效预防 SSI，但之前的研究已证明抗菌药物预防用药的时机、选择和持续时间过长。我们在此描述了对接受大手术的医疗保险患者使用抗菌药物预防。设计：国家回顾性队列研究和病历审查。背景：美国 2965 家急症护理医院。患者：对 34133 名接受冠状动脉旁路移植术的医疗保险住院患者进行系统随机抽样；其他开胸心脏手术（不包括移植）；血管手术，包括动脉瘤修复、血栓内膜切除术和静脉搭桥手术；一般腹部结直肠手术；髋、膝全关节置换术（不包括翻修手术）； 2001 年 1 月 1 日至 11 月 30 日期间进行经腹和经阴道子宫切除术。 主要结果指标： 在手术切口前 1 小时内开始肠外抗菌药物预防的患者比例；接受符合当前公布指南的预防性抗菌药物的患者比例；以及手术后 24 小时内停止抗菌药物预防的患者比例。 结果：55.7%（95% 置信区间 [CI]，54.8%-56.6%）的患者在切口前 1 小时内接受了抗菌药物剂量。 92.6%（95% Cl，92.3%-92.8%）的患者使用了符合已发布指南的抗菌药物。只有 40.7%（95% Cl，40.2%-41.2%）的患者在手术结束后 24 小时内停止抗菌药物预防。结论：对于接受大手术的患者，存在大量改善预防性抗菌药物使用的机会。
Hypothesis: Surgical site infections (SSIs) are a major contributor to patient injury, mortality, and health care costs. Despite evidence of effectiveness of antimicrobials to prevent SSIs, previous studies have demonstrated inappropriate timing, selection, and excess duration of administration of antimicrobial prophylaxis. We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery.Design: National retrospective cohort study with medical record review.Setting: Two thousand nine hundred sixty-five acute-care US hospitals.Patients: A systematic random sample of 34133 Medicare inpatients undergoing coronary artery bypass grafting; other open-chest cardiac surgery (excluding transplantation); vascular surgery, including aneurysm repair, thromboendarterectomy, and vein bypass operations; general abdominal colorectal surgery; hip and knee total joint arthroplasty (excluding revision surgery); and abdominal and vaginal hysterectomy from January I through November 30, 2001.Main Outcome Measures: The proportion of patients who had parenteral antimicrobial prophylaxis initiated within 1 hour before the surgical incision; the proportion of patients who, were given a prophylactic antimicrobial agent that was consistent with currently published guidelines; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery.Results: An antimicrobial dose was administered to 55.7% (95% confidence interval [CI], 54.8%-56.6%) of patients within I hour before incision. Antimicrobial agents consistent with published guidelines were administered to 92.6% (95% Cl, 92.3%-92.8%) of the patients. Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7% (95% Cl, 40.2%-41.2%) of patients.Conclusion: Substantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery.