De Almeida Mary, Gerard Catherine, Freeman Joshua T, Duffy Eamon, Roberts Sally A
Clinical Microbiologist, Department of Microbiology, Auckland City Hospital, Auckland.
Evaluation Manager, New Zealand Health Quality & Safety Commission, Wellington.
N Z Med J. 2018 May 18;131(1475):35-43.
This study aims to determine the indications for antibiotic use in patients discharged following major surgery at Auckland City Hospital (ACH); to determine if the indications were appropriate and to identify opportunities where antimicrobial stewardship interventions would be beneficial.
This was a retrospective study of adult patients who were dispensed an antibiotic within the first two days of discharge after major surgery at ACH between 1 January 2013 and 31 December 2013. The indication for antibiotic use was determined and subsequently classified as either 'appropriate', 'not assessable' or 'inappropriate'.
Among the 378 patients analysed, an indication for antibiotic use was not documented in 52 patients (13.8%). Antibiotics were prescribed for an established infection in 172 patients (45.5%), as empiric therapy in 100 patients (26.4%), and as prolonged surgical antimicrobial prophylaxis in 41 patients (10.8%). Overall, nearly half of the antibiotic courses dispensed (48.7%) were either 'inappropriate' or the indication was 'not assessable'.
This study demonstrates that a significant proportion of antibiotics prescribed in patients discharged following surgery are inappropriate and there is need for enhanced antimicrobial stewardship in this area.
本研究旨在确定奥克兰市医院（ACH）接受大手术后出院患者使用抗生素的指征；确定这些指征是否恰当，并找出抗菌药物管理干预措施可能有益的机会。
这是一项对2013年1月1日至2013年12月31日期间在ACH接受大手术后出院的头两天内使用抗生素的成年患者进行的回顾性研究。确定使用抗生素的指征，随后将其分类为“恰当”、“无法评估”或“不恰当”。
在分析的378例患者中，52例（13.8%）未记录使用抗生素的指征。172例患者（45.5%）因已确诊感染而使用抗生素，100例患者（26.4%）作为经验性治疗使用抗生素，41例患者（10.8%）作为延长的手术抗菌预防使用抗生素。总体而言，近一半的抗生素疗程（48.7%）要么“不恰当”，要么指征“无法评估”。
本研究表明，手术后出院患者所开具的抗生素中有很大一部分是不恰当的，该领域需要加强抗菌药物管理。
