Pollmann André S, Bailey Jon G, Davis Philip J B, Johnson Paul M
From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Pollmann, Bailey, Davis, Johnson); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Bailey, Davis, Johnson).
Can J Surg. 2017 Dec;60(6):388-393. doi: 10.1503/cjs.004317.
Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital.
Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines.
During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second- or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses.
Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment.
抗生素在治疗许多影响老年人的外科疾病中发挥着重要作用，且这些药物存在较高的不当使用可能性。我们的目的是描述在一家三级护理教学医院接受急性护理手术服务的老年人中抗生素的使用情况。
回顾性收集了70岁及以上入住急性护理手术服务的患者的详细诊断、合并症、手术及抗生素使用数据。我们根据已发表的指南评估抗生素使用（围手术期预防和治疗）的适宜性。
在研究期间，453名患者入住急性护理手术服务，229名接受了手术。最常见的诊断是小肠梗阻（27.2%）和急性胆囊炎（11.0%）。共进行了251例非选择性腹部手术，围手术期抗生素预防在49.5%的病例中是适宜的。最常见的预防错误是时机不当（15.5%）和剂量错误（12.4%）。总体而言，206名患者因其基础疾病接受了抗生素治疗，44.2%接受了适当的一线药物治疗。最常见的治疗错误是无指征使用二线或三线抗生素（37.9%）和无指征使用抗生素（12.1%）。相同诊断的患者治疗持续时间存在很大差异。
在入住急性护理手术服务的老年患者中，抗生素使用不当很常见。需要开展质量改进措施，以确保患者在这个复杂的医院环境中获得最佳护理。
