医院妇产科剖腹手术围手术期患者抗菌药物的应用调查

目的调查抗菌药物在妇产科剖腹手术围手术期的应用情况,旨在规范抗菌药物的临床合理应用。方法随机抽取2014年7月~10月临床资料完整的妇产科剖宫产围手术期患者511例进行回顾性分析,统计剖腹手术围手术期抗菌药物的使用频次、使用率以及联合用药情况。结果 511例患者中,使用抗菌药物503例,使用率98.43%,预防用药占99.59%,治疗用药占0.41%;其中以注射用头孢替安、注射用氨曲南等抗菌药物的使用率最高。另外,抗菌药物单用498例,使用率99%;二联5例,使用率1%;更换用药39例(7.75%);总应用合理为168例,不合理335例,不合理率为66.60%。结论我院剖腹手术围手术期抗菌药物的使用不太合理,存在着用药品种及用药时机选择不恰当等问题,应进一步加强监管,以保证用药安全、有效。     

应用分层加权逼近理想排序法评价剖宫产术中预防性使用抗菌药物

目的建立剖宫产手术预防性使用抗菌药物的量化评价体系，为科学、客观评价剖宫产术预防使用抗菌药物的合理应用提供参考。 方法以《抗菌药物临床应用指导原则(2015版)》、相关药品说明书、相关临床指南为依据，由药学部、产科专家共同讨论制定剖宫产手术预防性使用抗菌药物合理性评价标准。采用层次分析法对评价指标进行赋权，并利用逼近理想排序法对172例剖宫产手术患者的归档病历进行回顾性分析和合理性评价。 结果建立的评价标准包括4个一级指标和12个二级指标。172个病例中，预防用药合理的有80例(46.51%)，基本合理20例(11.62%)，不合理72例(41.86%)。 结论应用层次分析法加权逼近理想排序法对剖宫产围术期预防使用抗菌药物的合理使用进行综合评价，方法科学，结果可信，具有较广泛的临床适用范围。     

剖宫产手术围手术期抗菌药物应用分析

目的:对我院剖宫产手术围手术期抗菌药物的使用进行统计、分析、评价用药合理性。方法:对剖宫产病历2010年1月至9月的131例出院病历的相关数据进行分析。结果:全部手术均应用抗菌药物3.81%为单一用药,96.18%为二联用药,7.63%为三联用药。结论:目前存在的问题是剖宫产围手术期抗菌药物在术后使用时间长,品种偏高档,抗菌药物使用应用应用规范化,优化抗菌药物的使用。     

肾内科住院患者抗菌药物应用的临床分析

目的调查我院肾内科住院患者抗菌药物的应用情况,评价我院住院患者抗菌药物应用的合理性。方法在我院2009年1月-2010年12月肾内科住院患者病历中每月按随机抽取10份,共计240份,对肾内科抗菌药物的应用情况编制调查表然后进行统计分析。结果我院肾内科住院患者的抗菌药物使用率为53.75%,经验用药比例高达88.65%;围术期用药疗程不当,用药疗程1 d～24 d,平均6.2 d,用药疗程≤24 h的7例,占2.92%,用药疗程≤48 h的22例,占9.17%.结论我院肾内科的住院患者在抗菌药物应用上基本合理。     

临床路径在卵巢良性肿瘤手术治疗中的应用研究

目的:探讨临床路径管理在我院卵巢良性肿瘤手术治疗中的应用效果。方法:将已实施临床路径管理的卵巢良性肿瘤手术患者129例设为路径组,未实施临床路径管理的卵巢良性肿瘤手术患者128例作为对照组,对两组患者的住院天数、手术前住院天数、住院费用、药品费用、检查费用、药品费用比例、检查费用比例、术后并发症率和患者满意度等指标进行比较和评价。结果:路径组住院天数、手术前住院天数比对照组缩短,差异有统计学意义;路径组药品费用比对照组减少,但住院费用和检查费用较对照组增加,差异有统计学意义;路径组的患者满意度有所提高,但术后并发症率无明显改变。结论:临床路径应用于妇科卵巢良性肿瘤手术治疗中,规范了医疗行为,有效控制不合理医疗费用,有利于医疗资源的合理使用,促进医疗质量的持续改进。     

剖宫产围手术期预防应用抗生素临床观察

<正>近年合理应用抗生素日益受到广大医务工作者的重视,各级卫生行政部门也加大了对抗生素应用的监管力度。自2008年2月以来,我院产科严格按照卫生部《关于进一步加强抗菌药物临床应用管理的通知》的要求应用抗生素,现对2006年1月至2010年12月我院1200例剖宫产围手术期预防应用抗生素情况进行分析,探讨围手术期抗菌药物使用的     

围术期用药降低术后感染率的研究

目的：主要通过对妇产科手术的患者抗生素应用的监测,比较围术期用药和常规术后用药的比较来研究患者感染数及住院天数。方法：采用回顾性调查与前瞻性检测相结合的方法,比较围术期预防性应用抗菌药物组与常规传统用药两组在切口感染、平均住院日、住院费用等方面的差异。结果：围术期用药组与常规用药两组相比,前者术后感染率较低,且平均住院日短,住院费用低。结论：围术期用药可明显降低术后感染,减少患者住院天数,减少费用,对妇产科术后感染具有重要作用,且社会经济效益好。     

剖腹产围手术期院内感染的预防及干预措施

目的:探讨剖腹产围手术期院内感染的预防及干预措施。方法:对我院2010年1月至2010年12月剖腹产总人数中随机抽取140例剖腹产产妇围手术期及传统方法应用抗生素预防感染情况进行回顾性对比分析。把患者分为治疗组(70例)与对照组(70例),治疗组见术前30min～1h将生理盐水100ml,头孢噻肟钠4g快速静脉滴入。若手术超过4h,术中则增加用药1次,术后约7h重复用药1～2次。对照组术前不用抗生素,术后返病房后静脉滴注生理盐水100ml,头孢噻肟钠2g+灭滴灵100(0.5g),1次/日×7天。结果:(1)对照组院内感染率、术后发热均高于治疗组,可能因同时联合应用多种抗生素或过晚停药致菌群失调从而增加院内感染。两组术后切口、宫腔感染,血象恢复情况差异均无明显差异性。(2)两组术后发生院内感染:上呼吸道感染,治疗组3例(4.29%),对照组4例(5.71%)。腮腺炎,治疗组2例(2.86%),对照组5例(7.14%)。输液反应,治疗组1例(1.43%),对照组4例(5.71%)。以上病例体温均≥39℃,在统计学处理时将其剔除。两组术后切口、宫腔感染,血象恢复情况差异均无显著性。结论:剖腹产围手术期预防性使用抗生素安全、有效、剂量小、疗程短,效果可靠,用药安全方便,是围手术期应用抗生素较合理的方法,优于术后多日用药,值得继续推广使用。     

妇产科Ⅱ类切口围手术期预防应用抗生素的研究

目的对352例2014年8月至2016年1月上海市东方医院妇产科Ⅱ类切口手术患者预防性抗生素应用进行回顾性调查分析,探讨妇产科Ⅱ类切口围手术期抗生素预防使用存在的问题,以利减少抗生素的不合理应用。方法采用上海市东方医院病案室纸质病历管理系统,以"切口手术"为检索词,随机抽取上海市东方医院2014年8月至2016年1月妇产科住院病例400例,其中352例为Ⅱ类切口,对352例妇产科Ⅱ类切口手术患者的相关资料(年龄、性别、临床诊断、手术名称、手术时间、用药特征、用药时间、抗生素名称、以及联合用药、术后有无相关感染情况等)进行分析和统计。结果在352例妇产科Ⅱ类切口手术患者中,其中抗生素预防性用药352例(100%),联合使用两种抗生素10例(2.84%),预防性应用抗生素排在前3位的依次是第1代头孢菌素(头孢唑啉)、第2代头孢菌素(头孢替安)、林可酰胺类(克林霉素)。围手术期平均用药3 d。结论上海市东方医院妇产科围手术期Ⅱ类切口预防应用抗生素较规范,存在不规范的情况:无指征延长用药、需加强抗菌素应用规范的管理,提高临床用药的科学性。     

眼科手术抗菌药物的合理应用

目的:探讨和分析了眼科手术抗菌药物的临床使用情况,总结其临床应用价值,为临床上眼科手术抗菌药物的合理使用提供参考。方法:通过回顾性分析眼科手术抗菌药物的合理使用的原则,抗菌作用及给药方式、方法等,阐明其临床应用价值。结果:通过开展药敏试验,选取治疗性眼科手术抗菌药物,同时优化给药方案,可提高疗效,减少不良反应。结论:加强眼科手术抗菌药物的合理应用管理,提高合理应用的水平,可有效避免耐药性的发生。     

Antibiotic prophylaxis after abdominal hysterectomy--comparative analysis of two treatment patterns

OBJECTIVES: The aim of the study was to evaluate the efficacy of antibiotic prophylaxis after abdominal hysterectomy. Additionally we compared costs of the treatment patterns and the periods of hospitalization. MATERIALS AND METHODS: We studied 70 cases of women operated in I Obstetrics and Gynaecology Clinic in Wroclaw without serious internal diseases, divided in two groups: on the basis of the treatment patterns. RESULTS: We showed that: Antibiotic prophylaxis decreases the risk of infectious complications after surgery in patients with abdominal hysterectomy. We did not observe any essential therapeutic differences between short-term monotherapy and longterm combined antibiotic treatment in perioperative prophylaxis. CONCLUSIONS: Monotherapy should be a method of choice in antibiotic perioperative prophylaxis. Monotherapy essentially reduces the cost of surgery procedure.     

Clostridium difficile-associated diarrhea follows perioperative prophylaxis with cefoxitin

Clostridium difficile-associated diarrhea during prolonged therapy of obstetric and gynecologic infections is known to occur with use of all classes of antibiotics except vancomycin and the aminoglycosides. We present 11 cases of C. difficile-associated diarrhea which followed a short course of perioperative prophylaxis with cefoxitin during a 1-year period. Nine of the cases of C. difficile-associated diarrhea were among 162 women who received cefoxitin perioperative prophylaxis for cesarean section or hysterectomy, but none occurred in 85 women who received one of four other antibiotics for perioperative prophylaxis (p = 0.024, Fisher's exact test). The two other occurrences of C. difficile-associated diarrhea following perioperative prophylaxis with cefoxitin were in women who underwent exploratory laparotomy. We conclude that C. difficile-associated diarrhea is related to perioperative prophylaxis with cefoxitin.     

Defibrotide vs. calcium heparin in the prevention of deep vein thrombosis in gynecologic oncologic surgery]

Eighty-one patients were submitted to gynaecological malignancy surgery in a randomized study aimed at the evaluation of the efficacy of defibrotide (40 patients) and calcium heparin (41 patients) in perioperative prophylaxis. They were randomly allocated to defibrotide group (400 mg bid im starting one day before surgery and continuing until the 7th postoperative day) or calcium heparin group (5000 IU bid sc starting two hours before surgery and continuing likewise for 7 days). No cases of DVT diagnosed by means of a Doppler CW were observed in either treatment group. Laboratory parameters have shown similar modifications in the two treatment groups. Three cases of bleeding were observed in the calcium heparin group while no cases of bleeding were detected in the defibrotide group. The results obtained suggest that defibrotide is at least as effective as calcium heparin in perioperative DVT prevention and that the former drug has a possibly better tolerability profile, due to a decisively lower tendency to bleeding.     

Selection of patients for antibiotic prophylaxis in cesarean sections

We conducted a prospective, double-blind, randomized, placebo-controlled study of cefoxitin perioperative prophylaxis in 388 women having cesareen sections after labor or rupture of membranes. Private patients constituted 70% of subjects. Cefoxitin was chosen for its low toxicity and its broad spectrum against common obstetric pathogens including Bacteroides fragilis. Cefoxitin-treated women received 2 gm of drug intravenously at umbilical cord clamping and at 6 and 12 hours after surgery. Demographic and obstetric variables did not differ between the 190 placebo-treated women and the 196 cefoxitin-treated women. The morbidity rate from infection was significantly reduced by cefoxitin prophylaxis. Seven factors were significantly correlated with increased risk of infection after cesarean section: maternal age, socioeconomic status, race, gestational age, duration of internal fetal monitoring, use of intrauterine pressure catheter, and obesity. Cefoxitin prophylaxis resulted in significant decreases in infection incidence in women with one, two, and three risk factors, respectively, but the reduction was not significant in women with no risk factors. Length of hospital stay was not significantly reduced by cefoxitin prophylaxis but antibiotic use was decreased 24%.     

Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial.

OBJECTIVE: To compare the efficacy and treatment-related complications of low molecular weight heparin and external pneumatic compression in the prevention of venous thromboembolism of postoperative gynecologic oncology patients. METHODS: A total of 211 patients over age 40 years, undergoing a major operative procedure for gynecologic malignancy, were randomized to receive perioperative thromboembolism prophylaxis with either low molecular weight heparin (n = 105) or external pneumatic compression (n = 106). Demographic data and clinical outcome were recorded for each patient. All patients underwent bilateral Doppler ultrasound of the lower extremities on postoperative days 3-5 to evaluate for the presence of occult deep vein thrombosis. A follow-up interview 30 days after surgery sought to detect patients who developed deep vein thrombosis or pulmonary embolism after hospital discharge. RESULTS: Venous thrombosis was diagnosed in two patients receiving low molecular weight heparin and in one patient receiving external pneumatic compression. The frequency of bleeding complications, measured by the number of required perioperative transfusions, and estimated intraoperative blood loss was similar between the two groups. CONCLUSION: Low molecular weight heparin and external pneumatic compression are similarly effective in the postoperative prophylaxis of thromboembolism. The use of low molecular weight heparin is not associated with an increased risk of bleeding complications when compared with external pneumatic compression. We believe that both modalities are reasonable choices for prophylaxis in this high-risk group of patients.     

Postoperative infections and antibiotic prophylaxis in radical hysterectomy. Retrospective study]

Radical hysterectomy is associated with a high risk of postoperative infectious morbidity. A series of 73 patients who underwent abdominal radical hysterectomy with pelvic lymphadenectomy is presented. Hospital charts were reviewed to determine the influence of surgical characteristics and of different antibiotic prophylaxis regimens on postoperative septic complications. The overall incidence of postoperative infections was 31.5%; in 13 patients had urinary tract infections (17.7%), 3 surgical site-related infections (4.1%) and 6 febrile morbidity (8.2%). There were also 3 cases of phlebitis and 3 infectious events at distant sites. No interaction was observed between the examined risk factors and the overall infectious morbidity. Time of surgical procedure and average blood transfusion show a trend toward increased values in patients with complications compared to patients with regular postoperative course. The most important current controversy about the use of prophylaxis in radical hysterectomy concerns the duration of postoperative treatment. In this series the major part of the subjects received a long-term antibiotic prophylaxis regimen (greater than 72 hours), and only 18% received a perioperative prophylaxis. Women without postoperative complications were more frequently treated with a long-term antibiotic prophylaxis (82%) compared to women with infectious morbidity (65%). Moreover, in patients with complications, the proportion of cases who needed an additional antibiotic therapy was lower in the group receiving long-term prophylaxis (20%) compared to the short-term group (83%).     

Efficacy and safety of two cephalosporins in the perioperative prophylaxis in patients undergoing abdominal or vaginal hysterectomies or gynaecological laparotomies: a prospective randomized study

The aim of this study was to compare efficacy and safety of perioperative antibiotic prophylaxis in patients undergoing abdominal or vaginal hysterectomy or gynaecological laparotomy to improve the prevention of surgical wound infections. One hundred and ninety-nine patients were prospectively randomized into two groups: the first group (n = 100) received perioperative prophylaxis using 1 g cefotiam (Spizef) and 0.5 g metronidazole (Clont) intravenously 30 min before surgery, whereas the second group (n = 99) was treated with 2 g cefoxitin (Mefoxitin) intravenously, also 30 min before surgery. The efficacy of the perioperative antibiotic prophylaxis was assessed clinically and on the basis of laboratory parameters. No wound infections were observed in 97 patients (97%) of the cefotiam-treated group and in 94 patients (94%) of the cefoxitin-treated group. No systemic postoperative infections were observed in 81% of the patients treated with cefotiam combined with metronidazole and in 85% of the patients treated with cefoxitin. The good tolerability of the drugs administered was proven in 98% of the patients treated with cefotiam and metronidazole and in 97% of the patients treated with cefoxitin. In both groups 3 patients developed nausea and/or vomiting, respectively, due to the antibiotic prophylaxis. A low infection rate after gynaecological surgery was observed. Cefotiam as a low dosage combined with metronidazole was as effective as cefoxitin. Cephalosporins of the second generation in combination with metronidazole can, therefore, be considered effective and safe drugs in the prevention of postsurgical infections.     

Perioperative antibiotic prophylaxis in obstetrics and gynecology

This article reviews current opinions originating from Evidence Based Medicine regarding perioperative antibiotic prophylaxis in obstetrics and gynecology. The appropriate use of antibiotic prophylaxis constitutes one of the most effective preventive tools available for the obstetricians and gynecologists. Lack of antibiotic prophylaxis or their improper use may result in serious iatrogenic harm with potential medical but also economic and legal consequences.     

Once again: the perioperative antibiotic prophylaxis in cesarean section

In continuation of our clinical observations on perioperative prophylaxis by application of Halospor and Gentamicin the dosage of Halospor has been reduced to 2 grams once only. According to our experiences in 98 cases of cesarean section we can recommend these advance: fever in 12.2% (21.2% without prophylaxis), secondary wound-healing in 2% (6.7%) and therapeutical antibiotics in 13.3%, Metronidazol as often as not (36.6%).     

Antimicrobial prophylaxis in obstetric and gynecologic surgery: a critical review

Thirty-three human studies concerned with antimicrobial prophylaxis in obstetric-gynecologic surgery were analyzed, with particular attention to experimental design. Eighty-two percent of the studies were prospective, 70% randomized and 39% double-blind. Patients were stratified according to underlying disease in 15%, complications of prophylaxis were mentioned in 61% of the studies, and statistical analysis was done in 55% of the studies. There was considerable variation in antibiotics employed and in the types of infection encountered. Twenty-seven of the 28 papers published after 1966 advocated prophylaxis. In contrast, less than two thirds of the papers concerned with general surgery support the use of perioperative prophylactic antibiotics. Despite some variability in methodology and antibiotic agents used, there is little controversy among the studies analyzed.