Takahashi Hiroshi, Wada Akihito, Iida Yasuaki, Yokoyama Yuichiro, Katori Susumu, Hasegawa Keiji, Shintaro Tsuge, Suguro Toru
Department of Orthopaedic Surgery, Toho University Medical Care Center, Ohmori Hospital, 6-11-1 Ohmori-nishi, Ohta-ku, Tokyo, 143-8541, Japan.
J Orthop Sci. 2009 Jan;14(1):40-4. doi: 10.1007/s00776-008-1296-5. Epub 2009 Feb 13.
The concept of antimicrobial prophylaxis (AMP) did not exist in Japan until recently. Therefore, postoperative administration of antimicrobial drugs has long been practiced under the pretext of prophylaxis against surgical site infection (SSI). In recent years, however, the concept of AMP and prophylactic countermeasures against SSI, based on evidence of the effectiveness of AMP, has gradually spread in Japan. From 2000 onward, we have undertaken prophylactic countermeasures against SSI in patients undergoing spinal surgery referring to the Guideline for Prevention of Surgical Site Infection published by the Centers for Disease Control and Prevention in 1999. The purpose of this study was to investigate the type of AMP that would be appropriate for spinal surgery and the manner in which it should be used.
The subjects were 1415 patients who underwent spinal surgery at our department from January 1990 to March 2008. The patients were classified into four groups according to the method of AMP administration: group 1, AMP was employed for 7 days, only postoperatively; group 2, initial AMP dosing was administered at the time of anesthesia induction, followed by administration of AMP for 5 days, including the day of the operation; group 3, initial AMP dosing was administered at the time of anesthesia induction, and AMP was administered for 3 days, including the day of the operation; group 4, the initial dosing was administered at the time of anesthesia induction, and AMP was administered for 2 days, including the day of the operation. The frequency of SSI was assessed in the four groups.
The frequencies of SSI in groups 1-4 were 2.6% (14/539), 0.9% (5/536), 0% (0/257), and 0% (0/83), respectively. Thus, the frequency of SSI decreased as the duration of the AMP administration period decreased.
As a result of thorough implementation of preventive measures against perioperative occurrence of infections, which included additional preoperative and intraoperative administration of AMP, the incidence of SSI could be decreased despite shortening the duration of AMP administration to 2 days.
直到最近，抗菌药物预防（AMP）的概念在日本才出现。因此，长期以来，术后使用抗菌药物一直是以预防手术部位感染（SSI）为借口。然而，近年来，基于AMP有效性证据的AMP概念和针对SSI的预防措施在日本逐渐传播开来。从2000年起，我们参照美国疾病控制与预防中心1999年发布的《手术部位感染预防指南》，对接受脊柱手术的患者采取了预防SSI的措施。本研究的目的是调查适合脊柱手术的AMP类型及其使用方式。
研究对象为1990年1月至2008年3月在我科接受脊柱手术的1415例患者。根据AMP给药方法将患者分为四组：第1组，仅在术后使用AMP 7天；第2组，在麻醉诱导时给予初始AMP剂量，然后包括手术当天在内给予AMP 5天；第3组，在麻醉诱导时给予初始AMP剂量，包括手术当天在内给予AMP 3天；第4组，在麻醉诱导时给予初始剂量，包括手术当天在内给予AMP 2天。评估四组患者的SSI发生率。
第1 - 4组的SSI发生率分别为2.6%（14/539）、0.9%（5/536）、0%（0/257）和0%（0/83）。因此，随着AMP给药期持续时间的缩短，SSI发生率降低。
由于全面实施了针对围手术期感染发生的预防措施，包括术前和术中额外给予AMP，尽管将AMP给药时间缩短至2天，但SSI发生率仍可降低。
