Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, and the Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York.
Obstet Gynecol. 2013 Dec;122(6):1145-53. doi: 10.1097/AOG.0b013e3182a8a36a.
To examine guideline-based use of prophylactic antibiotics in patients who underwent gynecologic surgery.
We identified women who underwent gynecologic surgery between 2003 and 2010. Procedures were stratified as antibiotic-appropriate (abdominal, vaginal, or laparoscopically assisted vaginal hysterectomy) or antibiotic-inappropriate (oophorectomy, cystectomy, tubal ligation, dilation and curettage, myomectomy, and tubal ligation). Antibiotic use was examined using hierarchical regression models.
Among 545,332 women who underwent procedures for which antibiotics were recommended, 87.1% received appropriate antibiotic prophylaxis, 2.3% received nonguideline-recommended antibiotics, and 10.6% received no prophylaxis. Use of antibiotics increased from 88.0% in 2003 to 90.7% in 2010 (P<.001). Among 491,071, who underwent operations for which antibiotics were not recommended, antibiotics were administered to 197,226 (40.2%) women. Use of nonguideline-based antibiotics also increased over time from 33.4% in 2003 to 43.7% in 2010 (P<.001). Year of diagnosis, surgeon and hospital procedural volume, and area of residence were the strongest predictors of guideline-based and nonguideline-based antibiotic use.
Although use of antibiotics is high for women who should receive antibiotics, antibiotics are increasingly being administered to women for whom the drugs are of unproven benefit.
: III.
研究妇科手术患者中基于指南的预防性抗生素使用情况。
我们确定了 2003 年至 2010 年间接受妇科手术的女性。手术分为抗生素适用（腹部、阴道或腹腔镜辅助阴道子宫切除术）或抗生素不适用（卵巢切除术、膀胱切除术、输卵管结扎术、扩张和刮宫术、子宫肌瘤切除术和输卵管结扎术）。使用分层回归模型检查抗生素的使用情况。
在 545332 名接受推荐使用抗生素的手术的女性中，87.1%接受了适当的抗生素预防，2.3%接受了不推荐使用的抗生素，10.6%未接受预防。抗生素的使用从 2003 年的 88.0%增加到 2010 年的 90.7%（P<.001）。在 491071 名接受不推荐使用抗生素的手术的女性中，197226 名（40.2%）女性接受了抗生素治疗。不基于指南使用抗生素的情况也随着时间的推移而增加，从 2003 年的 33.4%增加到 2010 年的 43.7%（P<.001）。诊断年份、外科医生和医院手术量以及居住地是基于指南和不基于指南使用抗生素的最强预测因素。
尽管应该使用抗生素的女性抗生素使用量很高，但越来越多的女性正在接受抗生素治疗，而这些药物对她们的益处尚未得到证实。
III。
