Fennessy B G, Harney M, O'Sullivan M J, Timon C
Department of Otorhinolaryngology, The Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
Clin Otolaryngol. 2007 Jun;32(3):204-7. doi: 10.1111/j.1365-2273.2007.01440.x.
Prophylactic antimicrobial therapy is defined as the administration of an antimicrobial agent prior to contamination of previously sterile tissues or fluids, in an attempt to reduce the microbial burden of intraoperative contamination. Prophylactic antimicrobial therapy should cover the anticipated floral contamination, with therapeutic levels from incision to closure. There is level I evidence to support the use of prophylaxis in clean-contaminated head and neck procedures and tonsillectomy, while level II evidence fails to support the use of prophylaxis in clean head and neck procedures. The aim of this study was to evaluate the use, timing and appropriateness of antimicrobial prophylaxis perioperatively, in otorhinolaryngological/head and neck procedures. A total of 34/51 (66%) patients were administered antimicrobial agents prophylactically. Six of 19 patients (42%) who ought to have received prophylaxis did not, while six of 13 (46%) of those who did not require it received it. Administration was unsuitably timed in 14 of 34 (41%) operations. This study demonstrates unnecessary administration of antimicrobial agents perioperatively, subclinical intraoperative antimicrobial levels for prophylaxis and inconsistent documentation regarding prophylaxis in otorhinolaryngological/head and neck procedures in a general ENT unit.
预防性抗菌治疗的定义是在先前无菌的组织或液体受到污染之前给予抗菌剂，以试图减轻术中污染的微生物负荷。预防性抗菌治疗应覆盖预期的菌群污染，从切口到缝合保持治疗水平。有一级证据支持在清洁-污染的头颈部手术和扁桃体切除术中使用预防性抗菌治疗，而二级证据不支持在清洁的头颈部手术中使用预防性抗菌治疗。本研究的目的是评估耳鼻咽喉科/头颈部手术围手术期抗菌预防的使用情况、时机和合理性。共有34/51（66%）的患者接受了预防性抗菌剂治疗。19名应该接受预防性抗菌治疗的患者中有6名（42%）没有接受，而13名不需要预防性抗菌治疗的患者中有6名（46%）接受了治疗。在34例手术中有14例（41%）给药时机不合适。本研究表明，在一家普通耳鼻喉科单位的耳鼻咽喉科/头颈部手术中，围手术期存在抗菌剂的不必要使用、预防性抗菌治疗的术中亚临床水平以及预防性抗菌治疗记录不一致的情况。
