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[结肠手术中手术部位感染的发生率及抗生素预防的充分性:前瞻性队列研究]

[Incidence of surgical site infection in colon surgery and antibiotic prophylaxis adequacy: prospective cohort study].

作者信息

Del Moral Luque J A, Alonso García M, Gil Yonte P, Fernández Cebrián J M, Durán Poveda M, Rodríguez Caravaca G

机构信息

Hospital Universitario Fundación Alcorcón. Universidad Rey Juan Carlos..

出版信息

An Sist Sanit Navar. 2017 Dec 29;40(3):371-377. doi: 10.23938/ASSN.0045.

Abstract

BACKGROUND

Surgical site infection (SSI) has a considerable clinical and economic impact at the hospital level, so prevention and monitoring are considered a high priority. The objective of this study was to assess compliance with the protocol of antibiotic prophylaxis in colon surgery and the effect of its inadequacy for the incidence of SSI.

METHODS

Prospective cohort study from July 2008 to July 2016. Compliance with antibiotic prophylaxis protocol and the causes of non-compliance were evaluated in colon surgery: duration and starting, choice, route of administration and dose of the antibiotic. The incidence of SSI was studied after a maximum incubation period of 30 days. Relative risk (RR) was used to evaluate the non-compliance causes of prophylaxis.

RESULTS

The study included 771 patients. The cumulative incidence of SSI was 5.8% (n=45), of which 2/3 were superficial incisional infections. The most common cause of SSI was Escherichia coli (28%). Antibiotic prophylaxis was administered in 97.8% of patients, with an overall protocol compliance of 91.9%. The principle cause of non-compliance was the choice of antibiotic (58.2%). No relationship between the inadequacy of prophylaxis and incidence of surgical site infection was found (RR=0.5; CI95% 0.1-1.8).

CONCLUSIONS

The overall adequacy rate to antibiotic prophylaxis protocol was high. No significant association between the adequacy of prophylaxis and incidence of surgical site infection in colon surgery was found.

摘要

背景

手术部位感染(SSI)在医院层面具有相当大的临床和经济影响,因此预防和监测被视为高度优先事项。本研究的目的是评估结肠手术中抗生素预防方案的依从性及其不足对SSI发生率的影响。

方法

2008年7月至2016年7月的前瞻性队列研究。评估结肠手术中抗生素预防方案的依从性及不依从的原因:抗生素的持续时间和起始时间、选择、给药途径和剂量。在最长30天的潜伏期后研究SSI的发生率。采用相对风险(RR)评估预防措施不依从的原因。

结果

该研究纳入771例患者。SSI的累积发生率为5.8%(n = 45),其中2/3为浅表切口感染。SSI最常见的原因是大肠杆菌(28%)。97.8%的患者接受了抗生素预防,总体方案依从率为91.9%。不依从的主要原因是抗生素的选择(58.2%)。未发现预防措施不足与手术部位感染发生率之间存在关联(RR = 0.5;95%CI 0.1 - 1.8)。

结论

抗生素预防方案的总体充足率较高。未发现结肠手术中预防措施的充足性与手术部位感染发生率之间存在显著关联。

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