Department of Experimental Medicine, Second University of Naples, Naples, Italy.
PLoS One. 2013 Nov 13;8(11):e79532. doi: 10.1371/journal.pone.0079532. eCollection 2013.
The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy) and the factors associated with a poor adherence.
A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected.
Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA) score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin.
Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.
抗生素预防用药在预防和减少手术部位感染的发生率方面得到了广泛应用。本研究评估了在意大利阿韦利诺、卡塞塔和那不勒斯地区住院患者手术前预防性使用抗生素的合理性，以及与不合理用药相关的因素。
随机抽取了 23 个外科病房的 382 名住院患者作为样本，并在五家医院进行手术。
围手术期抗生素预防用药合理的比例为 18.1%。多变量逻辑回归分析显示，低蛋白血症、有临床感染、伤口清洁的患者更有可能接受适当的抗生素预防。与美国麻醉医师协会（ASA）评分≥4 的患者相比，ASA 评分为 2 的患者接受适当预防的可能性降低了 64%。预防性抗生素给药时机合理的比例为 53.4%。多变量逻辑回归模型显示，年龄较大、入住普通外科病房、未行内镜手术、手术时间较长以及 ASA 评分为 1 而选择 ASA 评分为≥4 作为参考类别的患者，预防性抗生素给药时机合理的可能性更高。不合理使用的最常见抗生素是头孢他啶、舒他西林、左氧氟沙星和替考拉宁。
需要进行教育干预，以提高围手术期适当的抗生素预防。
