Dornfeld Mark, Lovely Jenna K, Huebner Marianne, Larson David W
1 St Olaf College, Northfield, Minnesota 2 Pharmacy Services, Mayo Clinic, Rochester, Minnesota 3 Department of Statistics and Probability, Michigan State University, East Lansing, Michigan 4 Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota.
Dis Colon Rectum. 2017 Sep;60(9):971-978. doi: 10.1097/DCR.0000000000000807.
Despite distant historical studies that demonstrated the adequacy of preoperative antibiotic prophylaxis, current surgical practice continues to use antibiotics for postoperative coverage up to 24 hours.
The aim of this study was to evaluate a change in antibiotic prophylaxis duration and its effect on surgical site infection in a high-volume modern colorectal practice.
A case-controlled series retrospectively reviewed outcomes through a prospective validated data base.
The study was conducted at Mayo Clinic, Rochester, Minnesota.
A total of 965 patients were evaluated. Our study analyzed patient outcomes related to surgical site infection comparing cohort 1 (2012-2013), which had the same antibiotic coverage preoperatively up to 24 hours postoperatively, and cohort 2 (2014-2015), which eliminated postoperative doses and relied solely on pre- and intraoperative dosing duration.
The primary outcomes of this study are superficial and deep surgical site infection.
There were no differences identified for superficial or deep surgical site infection rates between cohorts. Before the change in antibiotic dosing duration (2012-2013), 28 of 493 patients (5.7%) vs after the practice change (2014-2015), 25 of 472 patients (5.3%) were reported to have superficial or deep surgical site infection (p = 0.794).
This study is limited by its retrospective design within a single institution.
These equivalent results present an opportunity for surgeons to reconsider optimal antibiotic duration and minimize unnecessary antibiotic dosing. See Video Abstract at http://links.lww.com/DCR/A322.
尽管早期的历史研究表明术前抗生素预防是充分的，但目前的外科手术实践仍继续使用抗生素进行术后长达24小时的覆盖。
本研究的目的是评估在大量现代结直肠手术中抗生素预防持续时间的变化及其对手术部位感染的影响。
一项病例对照系列研究通过前瞻性验证数据库对结果进行回顾性分析。
该研究在明尼苏达州罗切斯特市的梅奥诊所进行。
共评估了965例患者。我们的研究分析了与手术部位感染相关的患者结局，比较了队列1（2012 - 2013年）和队列2（2014 - 2015年），队列1术后24小时内术前术后使用相同的抗生素覆盖，队列2消除了术后剂量，仅依赖术前和术中给药持续时间。
本研究的主要结局是浅表和深部手术部位感染。
队列之间浅表或深部手术部位感染率未发现差异。在抗生素给药持续时间改变之前（2012 - 2013年），493例患者中有28例（5.7%），而在实践改变后（2014 - 2015年），472例患者中有25例（5.3%）报告有浅表或深部手术部位感染（p = 0.794）。
本研究受限于其在单一机构内的回顾性设计。
这些等效结果为外科医生提供了一个机会，重新考虑最佳抗生素持续时间并尽量减少不必要的抗生素给药。见视频摘要：http://links.lww.com/DCR/A322 。
