Simon A-M, Dzierzek A-C, Djossou F, Couppie P, Blaise N, Marie M, Mahamat A
Unité des maladies infectieuses, tropicales et hygiène, centre hospitalier Andrée-Rosemon, avenue des Flamboyants, 97300 Cayenne, Guyane française.
Ann Fr Anesth Reanim. 2012 Feb;31(2):126-31. doi: 10.1016/j.annfar.2011.10.028. Epub 2011 Dec 6.
To assess physician compliance with guidelines for surgical antimicrobial prophylaxis practices and to identify factors associated with non-compliance.
In a prospective study of patients admitted for clean or clean contaminated surgery from February 1 to April 28, 2008, we assessed appropriateness of surgical antimicrobial prophylaxis indication (recommended and prescribed or not recommended and not prescribed) and administration (antimicrobial choice, dose, timing and duration). Overall compliance was achieved if all criteria of indication and administration were met. The overall non-compliance rate was estimated and was used as a dependent variable in a multivariate logistic regression analysis to identify factors associated with non-compliance.
In a total of 481 practices evaluated, appropriateness of indication and administration of surgical prophylaxis were respectively 83% and 56%. The overall compliance rate to guidelines for surgical antimicrobial prophylaxis was 37%. In a multivariate regression analysis, prescription of antimicrobial prophylaxis by a surgeon (RR: 3.4; CI 95%: 1.6-7.5), clean-contaminated surgery (RR: 2.2; CI 95%: 1.4-3.7), traumatology surgery (1.87; 1.1-3.3), digestive surgery (3.7; 1.8-7.5) and head or neck-related surgery (11.4; 2.3-56.3) were independent factors associated with non-compliance to guidelines for surgical antimicrobial prophylaxis.
This study confirmed previous findings on the impact of the type of surgery and the wound class contamination on the overall compliance rate. Furthermore, non-compliance was related to surgeon prescriptions. The compliance should be improved by specific measures after professional feedback.
评估医生对手术抗菌预防措施指南的依从性，并确定与不依从相关的因素。
在一项对2008年2月1日至4月28日因清洁或清洁-污染手术入院患者的前瞻性研究中，我们评估了手术抗菌预防指征（推荐并开具或未推荐且未开具）及给药（抗菌药物选择、剂量、时机和持续时间）的合理性。若指征和给药的所有标准均符合，则达到总体依从性。估计总体不依从率，并将其作为多因素逻辑回归分析中的因变量，以确定与不依从相关的因素。
在总共评估的481例手术中，手术预防指征及给药的合理性分别为83%和56%。手术抗菌预防指南的总体依从率为37%。在多因素回归分析中，外科医生开具抗菌预防药物（相对风险：3.4；95%置信区间：1.6 - 7.5）、清洁-污染手术（相对风险：2.2；95%置信区间：1.4 - 3.7）、创伤外科手术（1.87；1.1 - 3.3）、消化外科手术（3.7；1.8 - 7.5）以及头颈部相关手术（11.4；2.3 - 56.3）是与不遵守手术抗菌预防指南相关的独立因素。
本研究证实了先前关于手术类型和伤口类别污染对总体依从率影响的研究结果。此外，不依从与外科医生的处方有关。应在专业反馈后通过具体措施提高依从性。
