St Vincent's Hospital, Melbourne, VIC.
Med J Aust. 2010 Feb 1;192(3):141-3. doi: 10.5694/j.1326-5377.2010.tb03452.x.
To evaluate national practice for antibiotic prophylaxis in cardiac surgery with respect to the use of protocols, agent selection and duration of administration.
DESIGN, SETTING AND PARTICIPANTS: Two point-prevalence surveys of intensive care units in 24 public and 27 private hospitals performing cardiac surgery in Australia, conducted in 2004 and 2008, using a structured telephone questionnaire of the attending senior intensive care clinician in each unit.
Existence of a protocol in the unit for antibiotic prophylaxis, specific antibiotic agents used and their duration of administration.
Between 2004 and 2008, reported protocol use increased from 58% to 80% (P = 0.02), while concordance with version 13 of the Australian Therapeutic guidelines: antibiotic for both choice of agent and timing (duration of administration) remained around 10%. Use of multiple agents was common, as was continued antibiotic administration after completion of surgery. Over 4 years, the proportion of cardiac surgical units reporting vancomycin administration for routine valve surgery prophylaxis doubled to 62% (P < 0.001).
Despite an increase in reported protocol use for antibiotic prophylaxis in cardiac surgery, concordance with national antibiotic guidelines remained low, with duration of antibiotic administration deviating most from recommendations. Prophylactic vancomycin use appears to have increased substantially in recent years. Clinical implementation of recommended perioperative cardiac surgical antibiotic prophylaxis may not occur until supported by evidence from either a large prospective randomised study or standardised national surveillance of cardiac surgical site infection rates.
评估心脏外科学中抗生素预防用药的国家实践，具体涉及方案的使用、药物选择和用药时长。
设计、环境和参与者：2004 年和 2008 年，在澳大利亚 24 家公立医院和 27 家私立医院的重症监护病房中进行了两次时点患病率调查，由各单位主治重症监护临床医师通过结构电话问卷回答问题。
单位是否存在抗生素预防用药方案、具体使用的抗生素药物及其用药时长。
2004 年至 2008 年间，报告的方案使用率从 58%增至 80%（P = 0.02），但与第 13 版澳大利亚治疗指南的一致性（即药物选择和时机[用药时长]）仍保持在 10%左右。联合用药较为常见，术后仍继续使用抗生素。4 年间，常规瓣膜手术预防用药中万古霉素使用率增加了一倍，达到 62%（P < 0.001）。
尽管心脏外科学抗生素预防用药的报告方案使用率有所增加，但与国家抗生素指南的一致性仍然较低，抗生素用药时长与推荐方案的偏差最大。预防性使用万古霉素的情况近年来大幅增加。推荐的心脏外科学围手术期抗生素预防用药的临床实施，可能需要大样本前瞻性随机研究或心脏外科部位感染率的标准化国家监测提供证据支持后才能实现。
