北京4所三级甲等医院住院患者抗生素应用的对比分析

目的:了解北京4所医院住院患者抗生素的使用情况。方法:采用系统抽样方法,抽取北京友谊医院2000年和2004年住院病历各420例,北京天坛医院、北京宣武医院、北京同仁医院2000年和2004年住院病历各120例,共1560例,对抗生素应用情况进行回顾性调查。结果:北京友谊医院、北京天坛医院、北京宣武医院、北京同仁医院4所医院2000年和2004年住院患者抗生素的使用率分别为78.5%和78.7%(P=0.902),合理使用率分别为73.9%和65.6%(P=0.002)。其中,单纯预防性用药者、单纯治疗性用药者、用药指征不明确者、既用于治疗又用于预防者2年分别占38.4%和40.9%(P=0.375),27.5%和23.3%(P=0.094),1.3%和1.0%(P=0.587),32.8%和34.9%(P=0.457)。经验性用药和参考病原学检查用药2000年和2004年分别占98.0%和96.1%(P=0.043),2.0%和3.9%(P=0.043)。单联、二联、三联和四联及四联以上抗生素使用率2年分别为69.4%和67.0(P=0.308),27.3%和29.4%(P=0.366),3.2%和3.1%(P=0.959),0.1%和0.5%(P=0.379)。两年用药途径均以静脉(44.6%和48.1%,P=0.116)和全身用药(78.9%和79.7%,P=0.672)为主。2000年使用抗生素占前三位者分别为喹喏酮类、第二代头孢菌素和β-内酰胺酶抑制剂的复方制剂,2004年分别为喹喏酮类、第二代头孢菌素和大环内酯类。结论:临床工作中必须重视住院患者不合理应用抗生素现象。     

临床抗生素应用调查分析

目的:为临床合理应用抗生素提供科学依据,干预不合理用药,预防抗生素带来负作用,对抗生素的使用情况进行调查。方法:由调查员用统一规范的表格对2009年6月份全院住院的586例患者进行问卷调查。结果:作为治疗性用药,抗生素的使用率维持正常范围内,但存在经验用药等不合理应用抗生素现象。结论:要重视病原学、进一步掌握联合用药的指证,坚持合理、安全、有效的使用抗生素。     

围手术期预防应用抗菌药物调查分析

目的分析围手术期抗菌药物使用基本情况及存在问题。方法对全国118所三级综合性医院围手术期预防用药情况进行调研。随机抽取2006年9月11—17日和12月11—17日手术病历各15份,共计3557份,对围手术期预防应用抗菌药物的合理性进行分析评价。结果（1）围手术期预防性抗菌药物的使用率为98％;（2）用药种类：按频次高低排序前3位是三代头孢、二代头孢、喹诺酮类;三代头孢占用药者的50．4％,一代头孢只占16．0％;（3）每例平均用药天数：Ⅰ类切口为7．4d,Ⅱ类切口为7．6d,Ⅲ类切口为10．5d;（4）用药时机：手术开始前2h内用药者只占30．4％,手术结束后才用药者占52．2％;（5）16．7％病例无用药适应证;（6）在抗菌药物的用法、用量、药物更换以及联合用药的指征掌握、药物配伍等方面,也存在诸多不合理现象。结论118所医院围手术期抗菌药物使用率过高,疗程过长,在药物选择、用药时机、联合用药方面不合理、不规范的情况比较普遍,改进的空间较大。     

急性坏死性胰腺炎合并念珠菌感染

目的 探讨急性坏死性胰腺炎(ANP)合并念珠菌感染的诊治方法。方法 回顾分析78例ANP患者的临床资料,诊断由手术发现或cT检查确定,其中62例接受预防性抗生素治疗,16例未接受。每例均行血、尿、便、痰和创口引流液的培养和涂片镜检,检出念珠菌。结果78例ANP中共有14例发生念珠菌感染,发病率17．9％,死亡4例,死亡率28．6％;使用预防性抗生素组发病率19．4％,死亡率25．0％;未用预防性抗生素组的发病率12．5％,死亡率50．0％。结论 资料证明ANP合并念珠菌感染是一个值得重视的临床问题,预防性使用抗生素治疗ANP可预防严重继发性感染的发牛．但也同时会合并念珠菌感染。     

从循证医学看泌尿外科预防性抗生素的合理使用

在临床外科干预过程中,使用预防性抗生素是减少外科术后感染和并发症的有效方式。但随着预防性抗生素在临床外科术前的常规使用,不合理用药情况普遍存在,导致病患预防效果差,抗生素耐药性及药物副作用也不断增加。因此,在临床外科工作中如何合理使用预防性抗生素至关重要。本文分析了预防性抗生素在泌尿系外科治疗过程中的作用及疗效,希望为临床工作提供有用的信息。     

手术切口感染的预防用抗生素效果分析

抗生素的应用在手术部位感染(surgicalsiteinfection ,SSI)的预防中具有重要地位 ,但也有一定的危险性[1] 。盲目地预防性应用抗菌药物常难以达到预期的效果 ,相反会增加药物的毒副反应 ,诱导产生耐药菌株 ,干扰人体微生态平衡 ,导致内源性感染 ,合理地预防用药是降低抗菌药物使用率和合理应用抗菌药物地关键措施[2 ] 。为了探明手术切口感染较为合理有效地预防用药方法 ,争取以较短给药时间取得较好的预防效果 ,进一步加强手术切口感染预防使用抗生素的管理 ,促使广大临床医生更加合理地使用抗生素 ,我们对 1997年 1月至2 0 0 0年 5月 3…     

整形外科抗生素应用原则的初步探讨

目的　调查研究我院整形外科患者抗生素的应用状况。方法　随机抽取整形外科医院１９９７～１９９８ 年８４０ 例１ ０１４ 人次手术病案,统计分析应用抗生素的状况。结果　１ ００６ 人次应用抗生素（９９－２１ ％ ）,其中预防性应用抗生素１ ００３ 人次（ 占应用抗生素人次的９９－７０％ ）,治疗性应用抗生素３ 例（０－３０％ ）,联合用药７１ 例。抗生素种类以β内酰胺类为主（８６－６３％ ） 。静脉注射６０１ 例（５５－３９ ％） 。结论　存在滥用及不合理应用抗生素现象,预防性应用抗生素未遵循原则,用药时间及途径不合理,联合用药无指征等。初步提出整形外科抗生素应用原则。     

医院感染现患率横断面调查447例分析

目的:全面了解医院感染的现状、抗菌药物使用和院感漏报、药敏情况,更好地预防院内感染,防止传染病暴发流行。方法:我院各临床科室质控医师用1天的时间,采用横断面调查法,对2011年6月27日的住院患者进行医院感染现患率调查。结果:应查住院患者447人,实查425人,实查率为95%,发生医院感染20人,感染率为4.7%,抗生素使用率为47.2%,按抗生素应用目的分类,其中治疗用药占61.7%,预防用药占26.9%,预防+治疗用药占11.4%;其中单用药占抗生素使用率的66.7%,二联用药占31.3%,三联及以上用药占2.0%。药敏试验88例,占抗生素使用的43.8%,其中20例院内感染病例,药敏试验12例,占60%。结论:住院患者医院感染的发生率比较低,以呼吸道为主,且存在医院感染漏报现象;部分科室抗菌药物使用率高达100%,抗菌药物的使用在一定程度上存在不合理现象。     

整形外科医院住院患者预防性应用抗生素相关数据分析

目的:研究整形外科围手术期预防性应用抗生素的合理性。方法:抽取1989～2003年我院住院患者病历48958份,男26575例,女22383例,平均住院时间12.32天。分析评价我院整形外科患者围手术期预防性抗生素应用的合理性。结果:全组有46611例预防性应用抗生素,占住院患者总人数的95.21%。主要的药物种类为头孢菌素类、青霉素类和氨基糖苷类、甲硝唑等。联合用药占6352人次,占抗生素使用总人数13.62%。发生医院感染的359例次,占住院总数的4.79%。术后预防性使用抗生素的有39982人,占预防性应用抗生素总人数的85.78%。结论:医院应制订整形外科围手术期预防性抗生素使用规范来指导临床合理使用抗生素,建立抗生素应用微机管理监测系统,加大管理监控力度,使抗生素管理规范化、系统化。     

经皮肾镜取石术治疗鹿角形结石术前抗生素使用的对比研究

【摘要】 目的 探讨经皮肾镜取石术(PCNL)治疗鹿角形结石术前抗生素的使用,预防术后感染。方法〓选择96例无合并泌尿系感染的鹿角形肾结石拟行PCNL术的患者,分成两组,预防性用药组术前1小时给予抗生素,治疗性用药组术前予以头孢菌素治疗3天,对比术后菌尿、发热的发生率。结果〓预防性用药组49例,术后菌尿发生率18.4%,术后发热发生率26.5%;治疗性用药组47例,术后菌尿发生率4.3%,术后发热发生率10.6%,均低于预防性用药组(P<0.05)。结论〓对于无临床及实验室感染证据的鹿角形结石患者行PCNL术前应用抗生素3天,可有效降低术后菌尿及发热的发生率。     

Antibiotic therapy in Italy. Current data and proposals for the future

Data concerning antibiotic therapy in italian ICUs are presented. These data were not directly measured: they have been derived from a previous study on costs of intensive care treatments. 78% of 1065 patients received antibiotic therapy. Empirical therapy was started in 82% of septic patients. 93% of septic patients had at least one antibiogram. In 96% of cases, 2 or more antibiotics were given. 85% of surgical non septic patients received antibiotic prophylaxis for an average of 3.6 days, with a 3rd generation cephalosporin in the majority of cases. 60% of medical non septic patients received antibiotic prophylaxis for an average of 6.2 days, mostly with a 3rd generation cephalosporin. These data raise doubts about the proper use of prophylaxis. These data can be considered a useful starting point for the development of a program of surveillance of infections in Italian ICUs.     

Which antibiotics should one choose for prophylaxis in vascular surgery?

Although the principle and duration of prophylactic antibiotic therapy in prosthetic vascular surgery are fairly widely accepted, the choice of antibiotic is still open to discussion. During two successive periods, identical groups of patients received peri-operative prophylaxis with, during period I (455 cases) oxacillin alone and during period II (537 cases) combined treatment with oxacillin and amikacin. The aim of the study was to evaluate efficacy of the association and to draw general conclusions on choice of antibiotic. The addition of amikacin reduced frequency of infection in elective operations, particularly aorto-ilio-femoral prostheses (0.5% as against 1.24%), but not in operations conducted as emergencies. In addition, frequency of infection due to BGN fell only slightly. Finally, combined therapy with oxacillin-amikacin had 2 disadvantages: impossibility of using these antibiotics for prophylaxis alone as provided for in the protocol, and its high cost. Factors of choice of antibiotic should be: efficacy against germs encountered, which can vary from year to year, rarity of toxic or side effects, good tissue diffusion, the rare need for therapeutic use and a low cost.     

Use of antibiotics in the conjunction with extracorporeal lithotripsy

The first 400 patients treated on an inpatient basis at our center underwent bacteriological follow-up after extracorporeal lithotripsy (ECL) for ureteric or renal stones. 278 patients did not have any urinary tract infection on the urine culture before ECL. They did not receive any antibiotic prophylaxis and 4.8% of the patients developed infectious problems, with significant bacteriuria in only 1.5% of the cases. 89 patients had urinary tract infection on the preoperative cultures. 21.3% developed either fever or significant bacteriuria and this virtually always occurred in patients who were treated for less than 4 days before ECL, with septicemia in 4.5% of the cases. 33 patients with sterile urine received flush antibiotic prophylaxis and none of them developed postoperative infection. Two of these patients had infection at the time of the flush: one of them, who, by error, did not receive antibiotic treatment prior to ECL, developed bacteremia after the procedure. The rational use of antibiotics in conjunction with ECL should ensure effective prevention of urinary tract infections without requiring the excessive use of antibiotics.     

Survey of antibiotic prophylaxis in acute pancreatitis in the UK and Ireland

BACKGROUND: Current surgical practice with regards to antibiotic prophylaxis in acute pancreatitis in the UK and Ireland was overviewed. METHODS: The 1103 members of the Association of Surgeons of Great Britain and Ireland were surveyed by postal questionnaire. A total of 528 replies were received (48 per cent). Following exclusion of surgeons not treating patients with acute pancreatitis, analysis was carried out on 429 replies. RESULTS: Respondents treated a median of 12 (interquartile range (i.q.r.) 10-20) patients per year with acute pancreatitis. Prophylactic antibiotic therapy was used by 88 per cent of responding surgeons, of whom 24 per cent used it in all cases. For surgeons professing selective use of antibiotics, the most common indication for use was in patients with prognostically severe disease. A cephalosporin was prescribed in 72 per cent of patients; cefuroxime was the single most common antibiotic. Combination therapy with metronidazole was used in 48 per cent of attacks. The median duration of antibiotic therapy was 5 (i.q.r. 5-7) days. An adverse drug reaction attributable to the use of prophylactic antibiotics was reported by 11 per cent of respondents. CONCLUSION: This study has established that a significant body of clinicians charged with the responsibility of treating acute pancreatitis use antibiotic prophylaxis in the initial treatment of patients with predicted severe disease.     

Influence of broad-spectrum antibiotic prophylaxis on intracranial pressure monitor infections and subsequent infectious complications in head-injured patients

BACKGROUND: The benefit of antibiotic prophylaxis for intracranial pressure (ICP) monitors remains controversial, and clinical practice varies widely. Whether any antibiotic coverage, particularly broad-spectrum coverage, reduces monitor-related infections remains unproved, and exposure to antibiotics may affect the susceptibility patterns of pathogens producing subsequent infectious complications. Despite the lack of data supporting its use, our level I trauma center had a long-standing ICP monitor prophylaxis protocol that provided broad-spectrum coverage that included ceftriaxone. In April 2002, a protocol change was instituted that substituted cefazolin for ceftriaxone as single-agent prophylaxis for ICP monitors. HYPOTHESIS: Broader-spectrum antibiotic prophylaxis does not reduce ICP monitor-related infections but is associated with acquisition of more drug-resistant infections than narrow-spectrum prophylaxis. METHODS: To evaluate the influence of broad- versus narrow-spectrum prophylaxis, a three year period encompassing each practice was selected. All injured patients with ICP monitors placed between January 1, 2001, and December 31, 2003 (n = 279), were identified using the Vanderbilt trauma database. Antibiotic prophylaxis for ICP monitors was determined using the hospital financial database to identify all antibiotics given to individual patients and subsequent chart review to identify those antibiotics given solely for ICP prophylaxis. A total of 119 patients received narrow-spectrum (either cefazolin or vancomycin; n = 100) or no (n = 19) prophylaxis, whereas 160 received broad-spectrum prophylaxis (ceftriaxone or ciprofloxacin). The two groups did not differ with respect to baseline demographics, type of ICP monitor, or duration of monitor placement. Infectious complications were determined by continuous infection surveillance utilizing standard U.S. Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System (CDC-NNIS) definitions and maintained in a contemporary database. The influence of broad-spectrum antibiotic prophylaxis on both ICP monitor infections and subsequent infections outside the central nervous system (CNS) was determined. RESULTS: Nine patients (3.2%) developed CNS infections; two of 119 patients (1.7%) who received narrow-spectrum or no prophylaxis versus seven of 160 patients (4.4%) who received broad-spectrum prophylaxis (p = NS). Only the duration of monitor placement and Injury Severity Score were associated with the infection rate. In the total population, 185 infections occurred in 93 patients (33%). Infection rates did not differ between patients who received narrow-spectrum or no prophylaxis (32%) and those who received broad-spectrum prophylaxis (34%). However, patients who received broad-spectrum prophylaxis acquired gram-negative infections with significantly greater antibiotic resistance. CONCLUSIONS: Broad-spectrum antibiotic prophylaxis of ICP monitors does not reduce CNS infections, but is associated with a shift to resistant gram-negative pathogens in subsequent infectious complications. Thus, broad-spectrum antibiotic prophylaxis of ICP monitors should be eliminated or minimized unless data from randomized trials prove its utility.     

Pancreatic infection in severe pancreatitis: the role of fungus and multiresistant organisms

HYPOTHESIS: Recent controlled clinical studies suggest a positive effect of early antibiotic treatment on late morbidity and mortality in severe acute pancreatitis. However, widespread use of antibiotics may lead to an increased number of fungal infections and multiresistant bacteria, thereby worsening the outcome of the disease. DESIGN: Single-center prospective study. SETTING: University hospital, gastrointestinal surgical service. PATIENTS: One hundred three patients with necrotizing pancreatitis seen consecutively in our service. INTERVENTIONS: In addition to standard treatment, patients with proven necrotizing pancreatitis received a prophylactic intravenous antibiotic treatment. Pancreatic infection was regarded as an indication for surgery. MAIN OUTCOME MEASURES: Pancreatic infection, microbiological findings, drug resistance, fungal infections. RESULTS: Thirty-three patients (32%) had infected necrosis. Gram-negative organisms were isolated from 19 patients (58%), Gram-positive organisms were isolated from 18 patients (55%), fungal organisms were isolated from 8 patients (24%), and multiresistant organisms were isolated from 3 patients (9%). In 7 patients (21%), the organisms cultured from the pancreatic tissue were resistant to the antibiotics given in for prophylaxis. Infection with multiresistant organisms or organisms resistant to the antibiotic used for prophylaxis, but not with fungal infection or Gram-positive or Gram-negative infection, was correlated with a negative outcome. CONCLUSIONS: Fungal infection under adequate treatment is not associated with a negative outcome. The occurrence of multiresistant organisms seems to be a rare finding (3 of 103 patients). Antibiotic prophylaxis is effective in preventing infection in necrotizing pancreatitis, but optimal choice and duration of administration of the antibiotic agent(s) need to be carefully determined to avoid the sequelae of multiresistant organisms.     

Antibiotic prophylaxis in clean general surgery

Objective: To find out the incidence of surgical site infection in clean general surgery cases operated without prophylactic antibiotics. Design: A comparative study. Place and Duration of Study: The study was carried out in Combined Military Hospital, Pano Aqil Cantonment, from July 2003 to December 2004. Patients and Methods: One hundred and twenty-four clean surgical cases operated without antibiotic prophylaxis between July 2003 and December 2004, were studied and these were compared with similar number of cases who received antibiotics. The data was collected and analyzed using software SPSS (version 10.0). Chi-square and student "t" test were used to analyze the association between antibiotics and wound infection. Results: The most frequent operation was repair of various hernias, 69.3% in group A and 75% in group B. More operations were carried out between 21-30 years, 38.7% in group A and 41.9% in group B. Surgical site infection occurred in one patient (0.8 %) in each group. Chi- square test (0.636) applied to group A and B showed no association of infection and administration/ no administration of antibiotics (p > 0.25). The "t" test applied on group A and B (t=0) also showed no significant difference between administration of antibiotics/ no antibiotics and infection (p > 0.25). Conclusion: The use of prophylactic antibiotic in clean, non implant and elective cases is unnecessary.     

Optimum duration of prophylactic antibiotics in acute non-perforated appendicitis

BACKGROUND: The effect of extended prophylactic antibiotic therapy on postoperative infective complications such as wound infection and intra-abdominal abscess for non-perforated appendicitis is poorly defined. METHODS: In a randomized controlled trial of 269 patients aged 15-70 years with non-perforated appendicitis undergoing open appendicectomy; 92 received single dose preoperative (group A), 94 received three-dose (group B) and 83 received 5-day perioperative (group C) regimens of cefuroxime and metronidazole. Postoperative infective complication was the primary endpoint. Secondary outcomes included length of hospital stay and complications related to antibiotic therapy. RESULTS: The rate of postoperative infective complication was not significantly different among the groups (6.5% group A, 6.4% group B, 3.6% group C). The duration of antibiotic therapy had no significant effect on the length of hospital stay. Complications related to antibiotic treatment were significantly more common for 5-day perioperative antibiotic group (C) compared with single dose preoperative antibiotic group (A) (P = 0.048). CONCLUSION: Single dose of preoperative antibiotics is adequate for prevention of postoperative infective complications in patients with non-perforated appendicitis undergoing open appendicectomy. Prolonging the use of antibiotics can lead to unnecessary antibiotic related complications.     

Value of clinical decision on antibiotic treatment of fever episodes following transurethral resection of the prostate

The value of clinical decision on antibiotic treatment of fever episodes following transurethral resection of the prostate was assessed in 134 patients. Besides bacteriuria, need of blood transfusions and various catheter problems were associated with a significant number of fever episodes. The majority of patients with fever not given antibiotic therapy had negative urine cultures (90%), whereas 41% of the patients with fever treated with antibiotics showed negative urine cultures indicating an overtreatment of these patients. Out of the total number of patients, only 10% with subsequent negative urine cultures received antibiotics, a figure which should be compared to the inevitable rate of overtreatment when general antibiotic prophylaxis is preferred.