Health Care Informatics Section, Department of Health Policy, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 1138519, Japan.
Int J Qual Health Care. 2011 Apr;23(2):167-72. doi: 10.1093/intqhc/mzq080. Epub 2011 Jan 12.
To identify the factors associated with inappropriate antibiotic use during elective general surgeries.
Cross-sectional analysis of administrative dataset.
Sixty two acute-care hospitals in Japan.
Two thousand and three hundred and seventy-three patients who had undergone inguinal hernia repair, appendectomy or laparoscopic cholecystectomy in 2004 and 2005.
The appropriateness of antibiotic prophylaxis was evaluated in terms of the drug-selection and treatment-duration guidelines used in Japan, and the factors associated with guideline adherence were examined by multivariate logistic regression analysis.
The adherence rates for drug selection and treatment duration were 53-84 and 38-68% depending on surgical procedures, respectively. Patient age, sex and risk factors for surgical-site infections were not associated with inappropriate use of antibiotics after adjustment of other factors. The large size of the hospitals was significantly associated with inappropriate antibiotic usage. In hospitals with high surgical volume, the treatment duration was appropriate while antibiotic selection was relatively consistent but not adherent to the guidelines, implicating the presence of local practice routines.
Our results suggest that education and other methods should be used to encourage adherence to clinical guidelines on surgical antibiotic use, especially on duration of treatment. Increasing surgical volume may facilitate the standardization of clinical practice and improve the quality of health care.
确定与择期普外科手术中抗生素使用不当相关的因素。
行政数据集的横断面分析。
日本 62 家急性护理医院。
2004 年和 2005 年接受腹股沟疝修补术、阑尾切除术或腹腔镜胆囊切除术的 2373 名患者。
根据日本使用的药物选择和治疗持续时间指南评估抗生素预防的适当性，并通过多变量逻辑回归分析检查与指南遵守相关的因素。
根据手术程序，药物选择和治疗持续时间的遵守率分别为 53-84%和 38-68%。在调整其他因素后，患者年龄、性别和手术部位感染的危险因素与抗生素使用不当无关。医院规模较大与抗生素使用不当显著相关。在手术量大的医院，治疗时间是适当的，而抗生素的选择相对一致但不符合指南，这表明存在当地的实践惯例。
我们的研究结果表明，应使用教育和其他方法鼓励遵守外科抗生素使用的临床指南，特别是在治疗持续时间方面。增加手术量可能有助于临床实践的标准化，并提高医疗保健质量。
