Kim Kyoung Hoon, Park Choon Seon, Chang Jin Hee, Kim Nam Soon, Lee Jin Seo, Choi Bo Ram, Lee Byung Ran, Lee Kyoo Duck, Kim Sun Min, Yeom Seon A
Health Insurance Review & Assessment Service, Korea.
J Prev Med Public Health. 2010 May;43(3):235-44. doi: 10.3961/jpmph.2010.43.3.235.
To examine the prophylactic antibiotic use in reducing surgical site infection.
This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates.
The study population consisted of 16, 348 patients (1,588 gastrectomies, 2,327 cholecystectomies, 1,384 colectomies, 3,977 hysterectomies and 7,072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy.
This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.
研究预防性使用抗生素对降低手术部位感染的作用。
本研究为回顾性研究，研究对象为年龄在18岁及以上，接受过胃切除术、胆囊切除术、结肠切除术、剖宫产术和子宫切除术的患者。数据来源为健康保险审查与评估服务中心的质量评估数据，这些数据收集自302家国立医院的医疗记录。预防性使用抗生素的定义为：及时使用抗生素或抗生素选择不当。我们进行了分层逻辑回归分析，以检验预防性使用抗生素与手术部位感染之间的关联，并对协变量进行了校正。
研究人群包括16348例患者（1588例胃切除术、2327例胆囊切除术、1384例结肠切除术、3977例子宫切除术和7072例剖宫产术），其中351例（2.1%）患者发生了手术部位感染。及时使用抗生素和抗生素选择不当的发生率因手术方式而异。与未及时接受预防性抗生素治疗的患者相比，及时接受预防性抗生素治疗的胆囊切除术患者手术部位感染风险显著降低（比值比0.64，95%置信区间=0.50-0.83），但其他手术方式未观察到显著降低。当使用不当的预防性抗生素时，手术部位感染风险显著增加：胃切除术为8.26倍（95%置信区间=4.34-15.7），结肠切除术为4.73倍（95%置信区间=2.09-10.7），剖宫产术为2.34倍（95%置信区间=1.14-4.80），子宫切除术为4.03倍（95%置信区间=1.93-8.42）。
本研究探讨了及时使用抗生素、抗生素选择不当与手术部位感染之间的关联。及时且正确使用抗生素的患者手术部位感染风险降低。需要努力改善抗生素使用时机并使用合适的抗生素，以降低手术部位感染风险。
