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。     

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。     

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１０１４人次手术病案,统计分析应用抗生素的状况。结果 １００６人次应用抗生素（９９．２１％）,其中预防性应用抗生素１００３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－内酰胺灯为主（８６．６３％）。静脉注射６０１例（５５．３９％）。结论     

预防性抗生素在经会阴前列腺穿刺活检中应用的价值

目的通过两种经会阴前列腺穿刺活检围操作期准备的比较,评价预防性抗菌应用的价值。方法通过经会阴前列腺穿刺活检围操作期无预防性抗生素应用组与预防性抗生素应用组的比较来评估穿刺术后感染发生率。结果对1998年8月～2005年12月的661例患者进行了经会阴前列腺穿刺活检,其中无预防性抗生素应用组为350例,预防性抗生素应用组为311例。无预防性抗生素应用组与预防性抗生素应用组的术后发生尿路感染分别为2例(0．57%)和2例(0．64%)；发热者分别为2例(0．57%)和1例(0．32%)；LUTS者分别为31例(8．86%)和28例(9．00%),均无显著性差异。两组均无败血症、脓毒血症、前列腺脓肿和附睾炎发生。结论经会阴前列腺穿刺活检无需预防性应用抗生素。     

重视抗生素在烧伤临床的合理应用

机体烧伤后极易发生感染 ,且持续时间长 ,贯穿烧伤治疗的全过程。试图以某种抗生素或联合应用多种抗生素消灭病原菌是不可能的 ,但对于大面积深度烧伤 ,不应用抗生素也不现实[1,2 ] 。如果不合理使用抗生素 ,将引发更严重的耐药菌感染甚至二重感染 ,后果不良[3 -5] 。当前烧伤临床使用抗生素存在不少问题 :(1)适应证掌握不严。盲目地、不间断地使用抗生素 ,甚至逐步升级、轮番换药 ,不但达不到治疗效果 ,而且促进耐药菌株形成。 (2 )用药选择不合理。对抗生素的发展动态、各种新老抗生素的作用特点乃至对品种间的差异缺乏了解 ,选用时针对性不强。 (3)联合用药搭配不当。对抗生素的作用机制缺乏了解 ,应用有互相抵消作用的抗生素。 (4)用药方案不合理。抗生素的剂量、给药途径、用药方法不当 ,致使达不到有效浓度 ,引起不良反应。 (5 )不考虑耐药情况 ,忽略监测措施。故笔者强调 ,在烧伤临床治疗中使用抗生素 ,应分为预防性和治疗性两种情况。一、预防性使用抗生素的原则1.掌握好适应证 :其适应证是 :(1)大面积深度烧伤。 (2 )烧伤复合伤 :如烧伤合并吸入性损伤、骨折、内脏损伤等。 (3)烧伤面积较大 ,又具...     

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。     

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。     

周序辉

目的:了解抗生素在基层普外手术中的应用情况。方法:对5年间普外科手术患者使用抗生素情况以及对切口愈合、感染情况进行回顾性分析,并分析不同用药情况与切口感染的关系。结果:抗生素使用以青霉素类、头孢菌素类及喹诺酮类为主。300例普外手术患者中预防性给药77.3%,治疗性给药22.7%。术后切口甲级愈合占88.3%;切口感染率为3.3%,其中Ⅰ,Ⅱ,Ⅲ类切口感染率分别为0%,1.9%,15.6%,治疗性给药切口感染率显著高于预防性给药切口感染率(P<0.05),二联用药和用药时间长者切口感染率显著高于单一用药和用药时间短者(P<0.05)。切口感染以大肠杆菌为主。结论:抗生素使用应严格把握指征以及应用时机,避免多联、大剂量长时间用药,以减少菌种耐药发生。     

890例全髋关节置换术围手术期抗生素使用情况的分析

目的回顾分析2003～2008全髋关节置换(THA)患者围手术期抗生素的使用情况,为防治THA术后感染以及预防性抗生素的临床应用提供借鉴。方法全部病例来源于广州市三间三等甲级医院。调查资料包括患者的基本情况、住院时间、疾病诊断、合并疾病、院内感染、转科情况、围手术期抗生素使用情况。对抗生素的种类、使用时间、是否联合用药等进行一般统计学描述。结果患者住院天数为(22.42±7.98)d,总费用为(43127.87±15178.59)元。全部病例中,关节置换术后近期低毒性感染2例,3例为迟发性深部感染,2例为浅部感染,2例为晚期深部感染,感染率为0.8%。2.7%的患者术前3天开始使用抗生素,6.97%术前1天开始静脉使用抗生素,98.65%患者手术前1小时内使用抗生素。术后全部患者静脉使用抗生素预防感染,17.64%患者采用静脉联合用药,1.12%的患者使用了两种以上的抗生素联合用药。25.84%患者第一种抗生素停用后静脉使用了第二种抗生素,还有5.28%患者静脉使用了三种抗生素,22.81%静脉后改口服,20.45%患者出院继续口服抗生素。患者静脉抗生素使用时间为(8.91±4.42)d,抗生素使用总时间为(12.65±9.83)d。结论根据患者的具体身体状况以及手术创伤情况,使用抗生素预防THA是一种得到骨科医师认可的有效方法。由于比较严重的抗生素滥用,建议完善THA围手术期抗生素应用指南,明确抗生素的选择指征及使用方法,而临床医师则应该严格遵守指南选择应用抗生素。     

良性前列腺增生患者尿流动力学检查前预防性应用抗生素的研究

目的:探讨良性前列腺增生(BPH)患者行尿流动力学检查前预防性应用抗生素的有效性及安全性。方法:选取2010年10月至2012年10月行尿流动力学检查的BPH患者256例,随机分为两组,对照组(n=118)检查前不用预防性抗生素应用,试验组(n=138)检查前30 min用头孢西丁钠1.0 g静滴后由同一名医生行全套尿流动力学检查。对比两组患者尿路感染发生率。结果:对照组患者中发生尿路感染24例(20.3%),试验组10例(7.3%),两组结果有统计学意义(P<0.01)。合并糖尿病患者感染率试验组6.7%(3/45),对照组23.5%(8/34),两组对比有统计学意义(P<0.05);合并残余尿(>50 ml)患者感染率试验组5.4%(3/56),对照组18.5%(10/54),两组对比有统计学意义(P<0.05);合并糖尿病及残余尿患者感染率试验组9.5%(2/21),对照组44.4%(8/18),两组对比有统计学意义(P<0.05);试验组中仅有3例出现药物不良反应(2.2%)。结论:BPH患者,特别是合并糖尿病及残余尿患者,行尿流动力学检查前预防性应用抗生素能有效预防尿路感染的发生,且具有良好的安全性。     

Trends in preparation for colorectal surgery: survey of the members of the American Society of Colon and Rectal Surgeons

The utility of antibiotic and mechanical preparation for colorectal surgery is controversial, and numerous different regimens are used. The aim of this study was to detect trends in preparation for surgery among American colon and rectal surgeons. Members of the American Society of Colon and Rectal Surgeons practicing in the United States were surveyed with a postal questionnaire regarding their routine preparations for colon and rectal surgery. Five hundred fifteen (40%) of the 1295 questionnaires sent were returned. Eighty-one per cent of the respondents had completed an accredited colorectal training program, and the average experience in practice was 13.7 (+/- 8.7) years. Half of the surgeons felt that prophylactic oral antibiotic is essential, 41 per cent felt it was doubtful, and 10 per cent considered oral prophylaxis unnecessary. Despite these statements 75 per cent of the surgeons routinely utilized oral antibiotics (96% of them used a combination of two drugs), 11 per cent used them selectively, and only 13 per cent omitted oral prophylaxis from their practice. Similarly although the usefulness of intravenous antibiotics was questioned by 11 per cent of the surgeons 98 per cent routinely used them. The average number of postoperative doses was two (+/- 1.9). Although 10 per cent of the surgeons questioned the importance of mechanical preparation more than 99 per cent routinely used it. Forty-seven per cent of the surgeons used sodium phosphate, 32 per cent used polyethylene glycol, and 14 per cent alternated between these two options. We conclude that although the use of oral antibiotic prophylaxis for colorectal surgery is controversial among surgeons it is still routinely practiced by 75 per cent. Intravenous antibiotic prophylaxis and mechanical cleansing, however, are still a dogma and almost invariably used. There is a trend toward the use of a shorter course of postoperative intravenous antibiotics and the use of sodium phosphate for mechanical cleansing.     

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.     

Comparison of one dose versus three doses of prophylactic antibiotics, and the influence of blood transfusion, on infectious complications in acute and elective colorectal surgery

In a randomized prospective controlled trial involving 311 patients undergoing acute or elective colorectal surgery, the efficacy and safety of two different single dose and one triple dose regimen of antibiotic prophylaxis, as well as the influence of blood transfusion on postoperative infectious complications, were studied. Postoperative infectious complications occurred in a total of 59 patients (19.0 per cent). There were no major differences between the three treatment groups. Thirty-four patients (10.9 per cent) developed abdominal wound infection, 17 patients (5.5 per cent) intra-abdominal abscess and 16 patients (5.1 per cent) anastomotic leakage. Of 202 patients (65.0 per cent) requiring blood transfusion during hospitalization 57 (28.2 per cent; 95 per cent confidence limits of 23-36 per cent) developed infectious complications, whereas two non-transfused patients (1.8 per cent; 95 per cent confidence limits of 0.2 to 6 per cent; P less than 0.001) developed infectious complications. It is concluded that one single dose of antibiotic prophylaxis in acute and elective colorectal surgery is as protective as a triple dose regimen. The development of infectious complications despite antibiotic prophylaxis is strongly related to blood transfusion.     

Use of prophylactic antibiotics in orthopedic surgery

Summary The use of prophylactic antibiotics was studied prospectively in 2371 consecutive clean orthopedic operations. The infection rates for operations with obvious selection for antibiotic prophylaxis were twice as high (7.2%) as compared with operations with planned prophylaxis (3.4%) and with operations without such prophylaxis (3.7%).Sixteen per cent of all clean operations received antibiotics for prophylaxis and 85 per cent of all prophylactic courses lasted at least 8 days or longer. Fifty-one per cent of all antimicrobial drugs used during the study were administered for prophylaxis in clean orthopaedic operations. The length of the hospital stay was the only factor closely related to the length of antibiotic prophylaxis.The drugs most often used for prophylaxis were penicillinaseresistent penicillins. Significant increase of gram-negative pathogens was observed in cultures from wounds of patients on antibiotic prophylaxis.

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Zusammenfassung Wir untersuchten die Anwendung der prophylaktischen Antibiotika in einem lückenlosen klinischen Krankengut, bestehend aus 2371 reinen orthopädischen Operationen. Die Untersuchung war im voraus geplant.Die Infektionshäufigkeit für die Operationen mit deutlicher Auswahl für die antibiotische Prophylaxe war zweimal so hoch (7,2%) im Vergleich zu Operationen mit plangemäßer antibiotischer Prophylaxe (3,4%) und zu Operationen ohne antibiotischen Schutz (3,7%).In 16% von alien reinen Operationen wurde die antibiotische Prophylaxe benutzt. Fünfundachtzig Prozent von alien prophylaktischen Behandlungen dauerten 8 Tage oder mehr.Einundfünfzig Prozent von alien unter dem studierten Zeitraum verabreichter Antibiotika, wurden als Prophylaxe bei reinen orthopadischen Eingriffen benutzt.Die Dauer des Krankenhausaufenthaltes war der einzige Faktor von Bedeutung für die Dauer der antibiotischen Prophylaxe.Die penicillinaseresistenten Penicilline waren die für die Prophylaxe meist benutzten. Wir fanden eine signifikative Erhöhung der Häufigkeit der gramnegativen Bakterien in den Wunden der Patienten, die die antibiotische Prophylaxe enthielten.

     

Current practice in biliary surgery

A questionnaire enquiring about current practices in biliary surgery was sent to over 25 per cent of consultant general surgeons in the UK; 90 per cent replied. Only 56 per cent use antibiotic prophylaxis for elective cholecystectomy, and 84 per cent for emergency cholecystectomy. Duration of use, choice of agent and absence of prophylaxis for high-risk cases were inappropriate in up to 20 per cent of cases. Of the respondents 84 per cent routinely perform operative cholangiography and use T tubes, and 75 per cent routinely place a peritoneal drain after cholecystectomy. Despite controversies in the literature, most UK surgeons still follow traditional practices in biliary surgery.     

Prophylactic antibiotics in amputation of the lower extremity for ischemia. A placebo-controlled, randomized trial of cefoxitin

Of 152 patients who were scheduled for an amputation for ischemia, seventy-seven were randomly assigned to perioperative prophylaxis with cefoxitin (Mefoxin) and seventy-five patients, to injections of a placebo. The patients were followed for twenty-one days or, in the case of wound complications, to the end of treatment. An infected wound occurred in 38.7 per cent of the patients in the placebo group and 16.9 per cent of those in the antibiotic group (p less than 0.005). Clostridial infection occurred in eight patients in the placebo group and in none in the antibiotic group (p = 0.003). Three of the patients with clostridial infection died of gas gangrene. A multivariate analysis showed that the absence of antibiotic prophylaxis increased the risk of infection by a factor of 3.3 (p = 0.004) and increased the need for reamputation by a factor of 4.5 (p = 0.003). We concluded that amputation patients should have prophylaxis with a broad-spectrum antibiotic given perioperatively.     

Antibiotic prophylaxis in transurethral surgery

In a prospective randomized double-blind study, perioperative prophylaxis with cefoperazone, a third-generation cephalosporin, in transurethral surgery was evaluated. Cefoperazone significantly lowered the urinary tract infection rate from 17 per cent to 0 per cent, five to seven days postoperatively. Results from the latest placebo-controlled studies concerning antibiotic prophylaxis in transurethral surgery are summarized, and the use of antibiotic prophylaxis is discussed and recommended.     

Reducing the cost of surgical prophylaxis

A four-part program was implemented in order to control the rising cost of prophylactic antibiotics: limiting the number of cephalosporins on formulary; prohibiting the use of third- and most second-generation cephalosporins for prophylaxis; using a special order form to designate use as empiric, therapeutic, or prophylactic; and mandatory discontinuance of prophylactic antibiotics after 24 hours. The total cost for administration of prophylactic antibiotics was reduced from an average of $37.35 per case for the six months preceding the start of these restrictive policies to an average of $21.99 per case during the next twelve months. Class I and class II wound-infection rates were 2.0 per cent and 4.9 per cent, respectively, prior to the adoption of the new antibiotic practices. Comparable infection rates were 1.8 per cent and 2.1 per cent, respectively, after this program was initiated. The rising cost of antibiotic prophylaxis can be reduced without adversely affecting wound-infection rates.