预防儿童手术部位感染的抗生素预防性用药：一项前瞻性队列研究。

Antibiotic Prophylaxis to Prevent Surgical Site Infections in Children: A Prospective Cohort Study.

作者信息

Khoshbin Amir, So Jeannette P, Aleem Ilyas S, Stephens Derek, Matlow Anne G, Wright James G

机构信息

*Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada †Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; ‡Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada §Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Ontario, Canada ¶Center for Patient Safety, University of Toronto, Toronto, Ontario, Canada.

出版信息

Ann Surg. 2015 Aug;262(2):397-402. doi: 10.1097/SLA.0000000000000938.

DOI:10.1097/SLA.0000000000000938

PMID:25243561

Abstract

OBJECTIVE

To investigate the association between antibiotic prophylaxis (AP) and surgical-site infection in pediatric patients.

BACKGROUND

Surgical-site infections (SSIs) are a major cause of postoperative morbidity and mortality. Despite numerous studies in adults, benefit of AP in preventing SSIs in children is uncertain.

METHODS

Patients aged 0 to 21 years who underwent surgical procedures at a pediatric acute care hospital from April 1, 2009, to December 31, 2010, were assessed. Antibiotic prophylaxis indication and administration according to an evidence-based guideline were recorded. Complete compliance was defined as AP given, when indicated, within 60 minutes before incision. Surgical-site infections were identified using the Centers for Disease Control and Prevention criteria and documented in the medical records using the International Classification of Diseases, Tenth Revision. Multiple logistic regressions adjusting for age, sex, American Society of Anesthesiologists status, wound classification, admission status, surgical discipline, and surgical duration evaluated association of AP compliance and SSI.

RESULTS

Of 5309 patients for whom antibiotics were indicated, 3901 (73.5%) with complete compliance had an infection rate of 3.0%, whereas 1408 (26.5%) who were not compliant had an infection rate of 4.3% (adjusted relative risk: 0.7; 95% confidence interval: 0.5-0.9; P = 0.02). Of 4156 patients for whom antibiotics were not indicated, the 895 (21.5%) who received antibiotics had an infection rate of 1.7% compared with 0.7% in the 3261 (78.5%) who did not receive antibiotics (adjusted relative risk: 1.6; 95% confidence interval: 0.8-3.1; P = 0.18).

CONCLUSIONS

In pediatric surgery, complete compliance with AP was associated with 30% decreased risk of SSI.

摘要

目的

探讨儿科患者抗生素预防（AP）与手术部位感染之间的关联。

背景

手术部位感染（SSIs）是术后发病和死亡的主要原因。尽管在成人中有大量研究，但AP在预防儿童SSIs方面的益处尚不确定。

方法

对2009年4月1日至2010年12月31日在一家儿科急症医院接受手术的0至21岁患者进行评估。记录根据循证指南的抗生素预防指征和用药情况。完全依从性定义为在切口前60分钟内（如有指征）给予AP。使用疾病控制和预防中心的标准识别手术部位感染，并使用国际疾病分类第十版在病历中记录。通过对年龄、性别、美国麻醉医师协会状态、伤口分类、入院状态、手术学科和手术持续时间进行多因素逻辑回归分析，评估AP依从性与SSI的关联。

结果

在5309例有抗生素使用指征的患者中，3901例（73.5%）完全依从，感染率为3.0%，而1408例（26.5%）未依从的患者感染率为4.3%（调整后的相对风险：0.7；95%置信区间：0.5 - 0.9；P = 0.02）。在4156例无抗生素使用指征的患者中，895例（21.5%）接受了抗生素治疗，感染率为1.7%，而3261例（78.5%）未接受抗生素治疗的患者感染率为0.7%（调整后的相对风险：1.6；95%置信区间：0.8 - 3.1；P = 0.18）。