Baatrup Gunnar, Nilsen Roy M, Svensen Rune, Akselsen Per E
Department of Surgery, Haukeland University Hospital, and Institute of Surgery, University of Bergen, Bergen, Norway.
BMC Surg. 2009 Dec 7;9:17. doi: 10.1186/1471-2482-9-17.
The antibiotics used for prophylaxis during surgery may influence the rate of surgical site infections. Tetracyclines are attractive having a long half-life and few side effects when used in a single dose regimen. We studied the rate of surgical site infections during changing regimens of antibiotic prophylaxis in medium and major size surgery.
Prospective registration of surgical site infection following intestinal resections and hysterectomies was performed. Possible confounding procedure and patient related factors were registered. The study included 1541 procedures and 1489 controls. The registration included time periods when the regimen was changed from doxycycline to cephalothin and back again.
The SSI in the colorectal department increased from 19% to 30% (p=0.002) when doxycycline was substituted with cephalothin and decreased to 17% when we changed back to doxycycline (p=0.005). In the gynaecology department the surgical site infection rate did not increase significantly. Subgroup analysis showed major changes in infections in rectal resections from 20% to 35% (p=0.02) and back to 12% (p=0.003).
Doxycycline combined with metronidazole, is an attractive candidate for antibiotic prophylaxis in medium and major size intestinal surgery.
手术期间用于预防的抗生素可能会影响手术部位感染率。四环素具有半衰期长且单剂量使用时副作用少的优点，颇具吸引力。我们研究了中大型手术中抗生素预防方案改变期间的手术部位感染率。
对肠切除术和子宫切除术后的手术部位感染进行前瞻性登记。记录可能的混杂手术和患者相关因素。该研究包括1541例手术和1489例对照。登记内容包括方案从强力霉素改为头孢菌素以及再换回强力霉素的时间段。
当用头孢菌素替代强力霉素时，结直肠科的手术部位感染率从19%升至30%（p = 0.002），当换回强力霉素时降至17%（p = 0.005）。在妇科，手术部位感染率没有显著增加。亚组分析显示直肠切除术的感染有重大变化，从20%升至35%（p = 0.02），再降至12%（p = 0.003）。
强力霉素联合甲硝唑是中大型肠道手术抗生素预防的一个有吸引力的选择。
