220例剖宫产患者围手术期抗菌药物应用情况对比分析

目的分析抗菌药物整治前后剖宫产患者围手术期抗菌药物应用情况,为临床合理用药提供依据。方法采用回顾性分析方法,对我院产科2009年3～5月及2012年1～3月住院患者220份病历资料进行调查,探讨围手术期抗菌药物合理应用情况。结果抗菌药物整治前后剖宫产患者围手术期抗菌药物总的使用率分别为95.5%,94.4%,平均用药时间分别为4.7d,3.8d,最长预防用药时间分别为7d,6d。结论经过抗菌药物整治以后,剖宫产患者抗菌药物的使用率下降了1.1%,平均用药时间缩短0.9d,二联及三联用药比例分别下降了22.9%,2.6%。最长预防用药时间缩短1d。但是仍存在抗菌药物的品种选择不恰当,联合用药不合理,抗菌药物使用时间过长,用药时机不规范,用法用量不规范,标本送检率低等问题。应进一步加强抗菌药物使用监管,促进围手术期合理用药。     

某院剖宫产围手术期抗菌药物预防应用分析

目的：了解剖宫产围手术期抗菌药物使用情况,为抗菌药物合理应用提供参考。方法采用回顾性调查方法,抽取2012年第二季度～2013年第二季度剖宫产手术出院病历150例,对围手术期抗菌药物预防应用情况进行分析评价。结果剖宫产围手术期抗菌药物使用率为100%,均为单一用药。药品选择：使用的抗菌药物为第一代、第二代头孢菌素和头霉素类,共涉及7个品种,其中使用频次占比前3位的抗菌药物依次为头孢硫脒（42.0%）、五水头孢唑啉（38.7%）、头孢西丁（8.0%）。预防用药时机：自2012年第三季度起,所有患者均为结扎脐带后静脉给药。预防用药疗程：自2012年第三季度起,除手术部位感染转为治疗的2例外,其余病例预防用药疗程均没有超过48 h。结论自2012年第三季度起,我院剖宫产围手术期抗菌药物预防应用,在药品选择、预防用药时机和疗程等方面总体是合理的。     

剖宫产手术预防用抗菌药物856例的临床分析

目的 了解医院剖宫产围手术期预防用抗菌药物的现状,为医院临床合理用药提供依据.方法 对该院2012年1～12月856例剖宫产围手术期预防应用抗菌药物情况进行回顾性分析.结果 856例剖宫产围手术期100％应用了抗菌药物;药物以头孢替安、头孢西丁为主,联合用药214例（75.00％）,用药持续时间≥72h者526例,≤48h者25例,≤24h者305例;766例为断脐后给药,未发生手术部位感染者.结论 医院剖宫产围手术期预防用抗菌药物基本合理,但仍存在抗菌药物选择不合理及使用时间过长等,应进一步加强管理.     

综合干预措施对剖宫产手术部位感染的影响

目的：观察预防性应用抗生素和介入中医药、物理疗法的综合干预手段对剖宫产术后手术部位感染的影响。方法将120例受试者随机分入观察组和对照组,观察组采用预防性应用抗生素和介入中医药、物理疗法的综合干预手段,对照组只采用预防性抗生素,观察两组受试者在一般临床资料、手术时间、术中出血量、住院时间和术后感染发生率方面的差异。结果在住院时间,术后切口感染、宫腔盆腔感染等方面观察组明显优于对照组,且有统计学差异（P＜0．05或0．01）。结论预防性应用抗生素和介入中医药、物理疗法的综合干预手段对降低剖宫产术后手术部位感染和产妇的恢复有积极的作用。     

Antimicrobial prophylaxis of gastrointestinal surgical procedures and treatment of intraabdominal infections

Antibiotic prophylaxis and treatment regimens ideally are selected on the basis of efficacy, safety, and cost. This review evaluates current, selected literature on antibiotic prophylaxis for colorectal surgery, presumptive antibiotic administration following penetrating abdominal trauma, and treatment of intraabdominal infections. Single-drug regimens with the newer, broad-spectrum agents are assessed and compared with combination regimens; specific regimens are recommended. Colorectal procedures require an antimicrobial agent with activity against both aerobes and anaerobes. Patients undergoing elective colorectal procedures can be adequately protected with an orally administered three-dose regimen of neomycin/erythromycin. Parenteral antibiotic administration is generally not necessary, but, cefoxitin is recommended for nonelective colorectal surgery. The risk of potential infectious complications following penetrating abdominal trauma without colonic perforation is less than with colonic perforation; however, antibiotic therapy that includes activity against aerobes and anaerobes is recommended for all types of penetrating abdominal trauma. Although cephalothin, cefamandole, or cefoxitin alone may be used in abdominal trauma without perforation of the colon, only cefoxitin is recommended as a single-drug alternative to the standard clindamycin/gentamicin regimen in trauma with colonic perforation. Single-drug therapy with cefoxitin or moxalactam can be used successfully as alternatives to the standard regimens of clindamycin/gentamicin or metronidazole/gentamicin in many patients with intraabdominal sepsis. Single-drug regimens reduce the risk of developing adverse effects and are cost-effective. However, if resistant organisms are suspected, or if the patient has been hospitalized for a prolonged period or has multiple organ failure, it may be necessary to supplement cefoxitin therapy with an antibiotic that will enhance coverage against gram-negative aerobes.     

Multidisciplinary approach to cost reduction of C-section prophylaxis

Runaway cefoxitin costs prompted a thorough usage evaluation by the P & T Committee, the antibiotic review subcommittee, and the pharmacy department at this 450-bed teaching hospital. C-section prophylaxis accounted for 25% of all cefoxitin usage. With the assistance of the ob/gyn department, a major campaign was initiated to alter prescribing habits and evaluate more cost effective prophylaxis. Single dose cefotetan replaced multidose cefoxitin regimen for a 6-month trial basis. Annualized cost savings for drug and supplies were approximately $49,086, and no change in morbidity was noted. The ob/gyn department then agreed, at the request of the antibiotic subcommittee, to conduct a trial comparing single dose cefotetan with single dose cefazolin in women undergoing C-section. The results indicated that both treatments were equally effective, consequently, cefazolin replaced cefotetan, producing an additional $10,384 annual savings. Overall, our approach to C-section cost reduction resulted in a total of $59,470 annual savings and demonstrated the effectiveness of an organized multidisciplinary approach.     

剖宫产围手术期预防性应用注射用头孢唑林钠的回顾性分析

目的:回顾性分析剖宫产围手术期预防性应用抗菌药物的术后情况和不良反应。方法:将我院2006年3月-2010年10月剖宫产患者1062例均分为观察组和对照组。观察组于剖宫产术前30min快速以2g注射用头孢唑林钠加入5%葡萄糖注射液100mL中静脉滴注;在脐带结扎后立即静脉滴注替硝唑氯化钠注射液200mL。术后再以1g注射用头孢唑林钠加入5%葡萄糖注射液250mL中静脉滴注,bid,3d+替硝唑氯化钠注射液200mL静脉滴注,qd,3d。对照组将观察组用药中的头孢唑林钠替换为头孢孟多酯钠,其他用法用量同观察组。观察2组手术后产褥病率、体温恢复正常时间、切口感染、子宫腔感染、术后第3天血常规、术后平均住院时间和人均抗菌药物费用及不良反应等情况。结果:2组术后产褥病率、切口感染、子宫腔感染、体温恢复正常时间比较无显著性差异(P>0.05);2组术后第3天复查的血常规、白细胞总数和中性粒细胞比例比较无显著性差异(P>0.05)。2组术后平均住院时间比较也无显著性差异(P>0.05),但观察组人均抗菌药物费用显著低于对照组(57.30元vs.849.90元,P<0.05)。结论:剖宫产围手术期预防性应用注射用头孢唑林钠安全、有效、经济。     

剖宫产术后盆腔血肿的腹腔镜治疗探讨

目的探讨剖宫产术后盆腔血肿的诊断、治疗及预防。方法回顾性分析2例剖宫产术后发生盆腔血肿的临床资料及诊治经过。结果剖宫产术后盆腔血肿发生率为0.029%;行腹腔镜下血肿清除术,均治愈。结论合理选择剖宫产适应证和手术时机,提高操作技术和工作责任心,可减少盆腔血肿的发生。B超检查是诊断盆腔血肿的重要手段。腹腔镜治疗效果满意。     

Continuous versus intermittent infusion of prophylactic cefoxitin after colorectal surgery: a pilot study

STUDY OBJECTIVE: To compare 30-day postoperative surgical site infections (SSIs) and rates of antibiotic discontinuation within 24 hours after surgery in patients receiving continuous-infusion versus intermittent-infusion cefoxitin for postoperative antibiotic prophylaxis. DESIGN: Retrospective, cohort-matched pilot study. SETTING: Tertiary-care medical center. PATIENTS: One hundred sixteen adults undergoing colorectal surgery between August 1, 2004, and February 28, 2007. INTERVENTION: Cefoxitin prophylaxis was administered as a continuous infusion in 58 patients and as an intermittent infusion in 58 patients (controls). The controls received weight-based doses of cefoxitin (1 g if < or = 80 kg or 2 g if > 80 kg) every 8 hours for three doses, starting 3 hours after surgery and completed within 24 hours. The continuous-infusion group were given weight-based doses of cefoxitin (3 g if < or = 80 kg, 6 g if > 80 kg), started immediately after surgery and infused over 20 hours. MEASUREMENTS AND MAIN RESULTS: Patients and controls were matched according to colorectal procedure and risk index category. They were stratified by medium risk (50 patients) and low risk (66 patients) for the end point of 30-day postoperative SSI. For the 25 medium-risk patients who received the continuous infusion, a 50% relative reduction in the 30-day postoperative SSI rate was observed with continuous versus intermittent infusion (4% vs 8%, p=0.55). For the 66 low-risk patients, 30-day postoperative SSI rates were equal (3%) with both intermittent and continuous infusions. Risk stratification was not performed for the proportion of patients who discontinued antibiotic prophylaxis within 24 hours after surgery. All patients receiving the continuous infusion met this end point compared with 47 (83.9%) of the 56 controls (p=0.0015) included in the analysis. CONCLUSION: Compared with intermittent infusion, continuous infusion of cefoxitin for postoperative prophylaxis resulted in a nonsignificant reduction in 30-day postoperative SSI rates in medium-risk patients undergoing colorectal surgery. Continuous infusion also resulted in reliable discontinuation of postoperative prophylaxis within 24 hours.     

某院剖宫产患者围手术期抗菌药物使用分析

目的了解剖宫产围手术期预防应用抗菌药物情况,评价其合理性。方法采用回顾性调查方法,随机抽取我院2012年1-6月剖宫产手术出院病历300份,对剖宫产围手术期用药品种及频度、用药时间等情况进行分析。结果 300例剖宫产患者围手术期抗菌药物预防使用率为100%,共涉及5类11种,单用比例为78.3%,联合用药率为21.7%。结论我院剖宫产患者围手术期抗菌药物的预防使用仍存在不合理处,医院应进一步加强围手术期抗菌药物的使用管理,确保安全合理用药。     

Economic evaluation of pharmacologic therapy

Cost-benefit and cost-effectiveness analyses are defined and described, particularly as they apply to evaluating costs in pharmacologic therapy. The cost-benefit analysis (CBA) approach is used to compare dissimilar alternatives, whereas the cost-effectiveness (CEA) approach compares similar alternatives with similar objectives. A CBA, for instance, will demonstrate the economic effects of a program and can thus be used as a tool to compare the outcomes of several programs. A CEA, on the other hand, can help determine which of several alternatives is the least costly in achieving a stated objective. A CEA approach was used to examine results of clinical trials with cefoxitin or piperacillin in 86 patients undergoing intraabdominal surgery at two institutions. Results of multivariate analysis showed that patients who had received piperacillin had significantly shorter hospital stays (1.59 days) than those who had received cefoxitin. Based on national average hospital per diem rates, piperacillin patients were said to have saved $680 compared with patients treated with cefoxitin. Moreover, piperacillin was less expensive than cefoxitin.     

血常规检测用于指导剖宫产产妇围术期应用抗菌药参考范围调查

目的:调查剖宫产产妇围术期白细胞和中性粒细胞计数变化情况,指导围术期抗菌药物的合理使用。方法:采用回顾性分析方法,收集佛山市高明区人民医院2019年1—6月240例行剖宫产分娩的产妇临床和检验资料。分析临床预防使用抗菌药物维持时间与术后白细胞计数相关性,记录剖宫产前后白细胞及中性粒细胞计数,探索剖宫产产妇围术期白细胞计数参考范围。结果:临床预防使用抗菌药物维持时间大于24 h与术后白细胞计数呈正相关,剖宫产术后白细胞及中性粒细胞计数显著增加,术后第三天,白细胞计数及中性粒细胞计数均较前下降。待产产妇白细胞计数参考范围为(4.65~13.27)×10^9/L,剖宫产分娩产妇术后第一天白细胞计数参考范围为(8.44~20.08)×10^9/L。结论:剖宫产分娩产妇术后白细胞及中性粒细胞计数在短时间内增加是一种正常生理现象,不能作为细菌感染唯一指标,临床医生应综合情况合理使用抗菌药物。     

抗菌药物短程预防策略控制盆腔炎产妇剖宫产手术部位感染的效果评价

目的:评价围手术期短程(<24h)抗菌药物使用策略预防盆腔炎产妇剖宫产后手术部位感染的效果。方法:选择于我院接受剖宫产术后存在盆腔炎的产妇227例,将患者按预防方式分为短程(<24h)组109例和长程(>48h)组118例。对2组患者产妇孕程、体质量指数、住院前时间、术前白细胞数,是否初产、胎膜早破、妊娠高血压综合征(妊高征)、以及手术部位感染、术后子宫内膜炎、产褥病率、血象变化、抗菌药的使用频度(DDDs)和费用、新生儿评分与感染进行比较。结果:2组产前基本情况、手术时间、术中出血差异无统计学意义(P>0.05);2组均未见手术部位感染,子宫内膜炎、产褥病率及血象升高等差异无统计学意义(P>0.05);短程与长程预防策略用于抗菌药的费用支出差异有统计学意义(P<0.01),短程策略抗菌药物的DDDs仅约是长程策略的1/7(P<0.01);同时新生儿评分与感染等差异亦无统计学意义(P>0.05)。结论:头孢唑啉或联合甲硝唑短程策略(<24h)预防盆腔炎产妇手术部位感染效果与长程用药策略(>48h)相当,抗菌药物费用和用量明显下降。     

Antibiotic prophylaxis in cesarean section: use of cost per case comparison to influence prescribing practices

Results of a previously conducted DUE revealed that 91% of obstetric patients received antibiotic prophylaxis with cefoxitin despite the existence of obstetric department guidelines recommending the use of cefazolin. In the present DUE, antibiotic selection in C-section prophylaxis was reviewed and individual prescribers, both compliant and noncompliant with guidelines, were identified. Over a 2-month period, physicians who prescribed other than cefazolin for C-section prophylaxis were issued "Dear Doctor" letters, reminding them of existing guidelines. A significant change in prescribing patterns following this intervention was not demonstrated. A multidisciplinary approach was then undertaken. Prescribers were stratified by number of procedures, antibiotic requested, and antibiotic cost per case (average and median). Results were reviewed with Co-chiefs of Ob/Gyn. Letters to both compliant and noncompliant prescribers were issued. A grand rounds presentation describing the results of the DUE was also given. A follow-up review showed that the conversion to cefazolin prophylaxis reached 80%, with accompanied extrapolated yearly cost avoidance of nearly $5,500.     

我院221例剖宫产围手术期抗菌药应用分析

目的:了解我院剖宫产手术后患者应用抗菌药的情况,并评价其应用的合理性。方法:对我院2009年221例剖宫产手术患者围手术期抗菌药应用品种、使用率、联合用药、使用方法等进行统计分析。结果:221例剖宫产患者100%应用抗菌药。使用率最高的是头孢硫脒(45.7%);其中单一用药169例,二联用药52例,无三联及以上用药。结论:剖宫产患者在抗菌药的选择、开始用药时间、疗程等方面存在着不合理现象,应进一步加强剖宫产围手术期抗菌药的合理应用。     

Infection following caesarean section: a study of the literature and cases with emphasis on prevention

Many factors influence the incidence of sepsis following caesarean section. In Zimbabwe all caesars probably warrant prophylactic antibiotics. These should be given parenterally in high doses, starting peri-operatively. Single doses have been found effective. An overall 26 percent incidence of infection was found in 46 consecutive caesars at Hwange. Ruptured membranes for 6 hours or more, duration of operation 60 minutes or more, and post-operative haemoglobin less than 9.5 g percent were significantly associated with infection. A prolonged post-operative course of benzylpenicillin plus streptomycin appeared to have no advantage over three perioperative doses of chloramphenicol. The results support the contention that antibiotic prophylaxis for caesarean section should be perioperative, ensuring a high plasma concentration of antibiotic during the operation. Further study is needed to determine the best drug of combination and the optimum number of doses. Prophylaxis needed may vary with the degree of risk, but at present this cannot be reliably assessed.     

381例剖宫产患者围手术期抗菌药物使用调查分析

目的 了解剖宫产手术患者围手术期抗菌药物的使用情况,促进合理用药.方法 收集2011年1月～10月剖宫产手术病历381份,对其围手术期抗菌药物的使用情况进行统计、分析.结果 381例剖宫产患者围手术期抗菌药物的使用率100％,用药持续时间t≤48 h 56例(14.69％),48 h≤t≤72 h 144例(37.79％),t＞72 h 181例(47.50％);使用频次最高的是头孢哌酮舒巴坦钠256例次(36.05％)、其次是奥硝唑203例次(28.59％);术后100％用药,单用抗菌药63例(16.53％),二联用药307例(80.57％),三联用药11例(2.88％).结论 我院剖宫产患者围手术期抗菌药物的预防使用仍存在有不合理处,主要表现在品种的选择、给药时机及用药持续时间、联合用药等方面,医院应进一步加强围手术期抗菌药物的使用管理,确保安全合理用药.     

The choice of antibiotics for prophylaxis of postoperative infections in the field of orthopaedics. Clinical experience with cefoxitin

The clinical effects of cefoxitin (CFX) were evaluated in the prophylaxis of postoperative infections in the field of orthopaedics. The clinical response was good in 46 out of 50 patients; an efficacy rate of 92%. Four patients (8%) who did not respond to CFX were suffering from infections due to Mycobacterium tuberculosis (1), suspected Pseudomonas aeruginosa (1), and infection of unknown organism (2). A review was also made of recent trends among clinically isolated bacterial strains and their susceptibility to antibiotics in the field of orthopaedics. CFX is recommended as an antibiotic of first choice for the prophylaxis of postoperative infections in the field of orthopaedics.     

HBsAg阳性孕产妇剖宫产术抗菌药物预防用药调查与分析

目的：了解我院2005-2008年HBsAg阳性孕产妇剖宫产术抗菌药物预防应用的合理性。方法：采用回顾性分析方法,随机抽取480份剖宫产病例,对抗菌药物预防用药方案、联合用药、用药起始时间、用药费用及切口感染情况进行统计并评价其合理性。结果：480份剖宫产病例预防使用抗茵药物比例为100％,且均为静脉给药。预防药物以β-内酰胺类和甲硝唑为主,2005年和2006年两药联合预防的比例分剐为80．8％和87．5％,2007年后以单药预防为主。术前0,5～2h给药者占99．2％,但用药时间大于48h,且费用偏高。结论：我院HBsAg阳性孕产妇剖宫产术抗菌药物预防应用可以达到预防目的,但仍存在某些不合理处,需加强监测和管理。     

Effect of interventions on prescribing of antimicrobials for prophylaxis in obstetric and gynecologic surgery

The effect of interventions on the conformity of physicians with guidelines for the appropriate use of antimicrobial prophylaxis in obstetric and gynecologic surgery is reported. Guidelines on the appropriate use of antimicrobial prophylaxis in common obstetric and gynecologic surgical procedures were developed in late 1986 by the antibiotic subcommittee at a 1100-bed tertiary-care teaching facility. The guidelines were not adopted immediately by the department of obstetrics and gynecology (OB-GYN). An audit of the medical records of women who had received antimicrobial therapy for abdominal and vaginal hysterectomies and emergency cesarean sections during January through March 1987 showed that cefoxitin was used in 68% of the cases instead of the less expensive and equally efficacious cefazolin as recommended in the guidelines. The projected annual cost of this nonconformity was $26,500. After the subcommittee informed the physicians about the guidelines and the audit results, the OB-GYN department adopted the guidelines. A second audit performed one year later showed that cefazolin was used in the recommended manner in 93% of cases; projected annual cost savings were $25,000. Both audits showed that prophylactic treatment was inappropriately prolonged in 6% of cases. Substantial cost savings were realized by minimizing inappropriate antimicrobial drug use through efforts to promote rational and cost-effective therapy.