Páez Hospital M, Tamayo Gómez E, Soria García S, Martínez Escribano A, Herrero Gento E, Castrodeza Sanz J, Muñoz Fernández R
Hospital Universitario de Valladolid, Valladolid.
Rev Esp Anestesiol Reanim. 2003 May;50(5):225-9.
To evaluate the level of compliance with antibiotic prophylaxis during surgery in a university referral hospital.
A descriptive study of 257 patients undergoing clean or clean-contaminated elective surgery was carried out in 2001. Data were gathered prospectively by three anesthesiologists in the operating room. Prophylaxis was considered to have been administered correctly if the first dose was given before the skin incision, if a second dose was given during operations lasting longer than 240 minutes, and if the antibiotic prescribed was of a wide enough spectrum to cover the type of surgical procedure performed.
Prophylaxis was administered incorrectly to 132 patients (51.4%). The causes were administration after incision in 21.8%, long-duration surgery without a second dose in 15.6%, administration after incision plus long-duration surgery without a second dose in 3.1%, inadequate-spectrum antibiotic in 4.7%, administration after incision plus inadequate dose in 2.7%, inadequate dose in 1.9%, inadequate-spectrum antibiotic plus administration after incision in 0.8%, late second dose in 0.4%, long-duration surgery without a second dose plus inadequate dose in 0.4%.
The rates of late administration of an antibiotic or failure to administer a second dose during long-duration surgery is high.
To improve the low level of compliance and avoid late administration of antibiotics, we propose that the anesthetist be responsible for giving antibiotic prophylaxis and for directly monitoring compliance errors in the operating room.
评估一所大学附属医院手术期间抗生素预防性应用的依从性水平。
2001年对257例接受清洁或清洁-污染性择期手术的患者进行了一项描述性研究。数据由三名麻醉医师在手术室前瞻性收集。如果首剂在皮肤切开前给予、如果手术持续时间超过240分钟时给予第二剂、并且如果所开具的抗生素具有足够广的抗菌谱以覆盖所实施的手术类型，则认为预防性应用是正确的。
132例患者（51.4%）预防性应用不正确。原因包括切开后给药占21.8%、长时间手术未给予第二剂占15.6%、切开后给药且长时间手术未给予第二剂占3.1%、抗菌谱不足占4.7%、切开后给药且剂量不足占2.7%、剂量不足占1.9%、抗菌谱不足且切开后给药占0.8%、第二剂给药延迟占0.4%、长时间手术未给予第二剂且剂量不足占0.4%。
抗生素给药延迟或长时间手术时未给予第二剂的发生率很高。
为提高低依从性水平并避免抗生素给药延迟，我们建议麻醉医师负责给予抗生素预防性用药并直接监测手术室中的依从性错误。
