Garey Kevin W, Amrutkar Paresh, Dao-Tran Thanh K, Frost Craig P, Chen Hua, Essien E James, Gentry Layne O
University of Houston College of Pharmacy, Houston, Texas, USA.
Pharmacotherapy. 2008 Jun;28(6):699-706. doi: 10.1592/phco.28.6.699.
To determine if appropriate timing of vancomycin prophylaxis in patients undergoing cardiovascular surgery results in an economic benefit by assessing the differences in total duration of hospitalization and hospital costs based on infusion start time in relation to first surgical incision.
Prospective, observational study.
Tertiary care medical center.
A total of 1666 patients undergoing coronary artery bypass graft (CABG) and/or valve replacement surgery who received prophylactic vancomycin.
Appropriateness of vancomycin prophylaxis timing, based on national guidelines defining appropriate timing as start time of infusion ranging from 16-120 minutes before surgery start time, was prospectively monitored. The timing of vancomycin administration was grouped as follows: 0-15 minutes (11 patients), 16-60 minutes (156), 61-120 minutes (772), or more than 120 minutes (727) before incision. Antibiotic timing was appropriate in 928 patients and inappropriate in 738 patients. Length of hospital stay and total hospital costs were compared based on appropriateness of therapy by using multivariate linear regression and validated with a Heckman two-stage model. Median numbers of hospitalization and intensive care unit days were significantly fewer in patients given appropriate prophylaxis at an appropriate time (9 and 2 days, respectively) compared with inappropriate time (10 and 3 days, respectively, p<0.001 for both analyses). Hospital costs were significantly lower in patients who had appropriate timing of antibiotic prophylaxis (median $25,321, interquartile range [IQR] $19,429-35,471) compared with inappropriate timing (median $29,475, IQR $21,507-46,488, p<0.001). Multivariate linear regression and a Heckman two-stage model confirmed that appropriate antibiotic prophylaxis timing was associated with decreased hospitalization duration and hospital costs.
In patients undergoing CABG or valve replacement surgery, the administration of vancomycin 16-120 minutes before incision significantly reduced patient hospitalization duration and total hospital costs.
通过评估万古霉素预防性用药的输注开始时间与首次手术切口时间的关系，比较住院总时长和住院费用的差异，以确定心血管手术患者万古霉素预防性用药的合适时机是否能带来经济效益。
前瞻性观察性研究。
三级医疗中心。
共有1666例接受冠状动脉旁路移植术（CABG）和/或瓣膜置换手术并接受万古霉素预防性用药的患者。
根据国家指南将万古霉素预防性用药的合适时机定义为手术开始时间前16 - 120分钟的输注开始时间，前瞻性监测万古霉素预防性用药时机的适宜性。万古霉素给药时间分组如下：切口前0 - 15分钟（11例患者）、16 - 60分钟（156例）、61 - 120分钟（772例）或超过120分钟（727例）。928例患者抗生素用药时机合适，738例患者用药时机不合适。通过多变量线性回归比较住院时长和总住院费用，并使用Heckman两阶段模型进行验证。在合适时间接受合适预防性用药的患者，其住院天数和重症监护病房天数的中位数显著少于用药时机不合适的患者（分别为9天和2天，而不合适组分别为10天和3天，两项分析的p值均<0.001）。抗生素预防性用药时机合适的患者住院费用显著低于用药时机不合适的患者（中位数25,321美元，四分位间距[IQR]为19,429 - 35,471美元），而不合适组为中位数29,475美元，IQR为21,507 - 46,488美元，p<0.001）。多变量线性回归和Heckman两阶段模型证实，合适的抗生素预防性用药时机与缩短住院时长和降低住院费用相关。
在接受CABG或瓣膜置换手术的患者中，在切口前16 - 120分钟给予万古霉素可显著缩短患者住院时长和降低总住院费用。
