Duclos Gary, Pastene Bruno, Depeyre Fanny, Meresse Zoé, Cassir Nadim, Martin-Loeches Ignacio, Einav Sharon, Zieleskiewicz Laurent, Leone Marc
Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix Marseille Université, Marseille, France.
Unité de Recherche sur les Maladie Infectieuses et Tropicales Émergentes, Aix Marseille Université, Marseille, France.
Ann Transl Med. 2018 Oct;6(20):402. doi: 10.21037/atm.2018.09.56.
Surgical antimicrobial prophylaxis (SAP) is supported by evidence-based guidelines. Nevertheless, SAP guidelines do not cover all clinical scenarios. To our knowledge, no information is available regarding SAP in the critically ill patients. We designed a retrospective, observational and preliminary study which the objective was to describe our professional practices in intensive care unit (ICU) patients requiring SAP.
All patients admitted for more than 48 h in the ICU and requiring surgery were retrospectively included from January 1 to December 31, 2016. We collected data related to infection, colonization and antimicrobial treatments pre- and post-operatively. We assessed the compliance of SAP to guidelines.
Among 41 included patients, 13 (32%) were treated for an ongoing infection and 21 (51%) received at least one antibiotic during the ICU stay. Seven (17%) were colonized. Twenty-one (51%) patients received SAP according to guidelines. Thirteen postoperative infections including 1 surgical site infection were reported. For 10 (24%) patients, the ongoing antimicrobial treatment was continued in the operating room. No surgical site infection and 1 lung infection was reported. In 3 (7%) patients, no SAP was administered and 1 episode of bacteremia was noted. Three (7%) patients had their ongoing treatment changed in the operating room. Two of them developed a lung infection. The other patients were assessed individually due to complex conditions.
These preliminary data showed a large heterogeneity in the management of SAP in the ICU, suggesting the need for specific guidelines based on clinical trials.
外科抗菌药物预防性应用（SAP）有循证指南支持。然而，SAP指南并未涵盖所有临床情况。据我们所知，尚无关于重症患者SAP的相关信息。我们设计了一项回顾性、观察性的初步研究，目的是描述我们在需要SAP的重症监护病房（ICU）患者中的专业实践。
回顾性纳入2016年1月1日至12月31日期间入住ICU超过48小时且需要手术的所有患者。我们收集了术前和术后与感染、定植及抗菌治疗相关的数据。我们评估了SAP对指南的依从性。
在纳入的41例患者中，13例（32%）因正在进行的感染接受治疗，21例（51%）在ICU住院期间至少接受了一种抗生素治疗。7例（17%）发生定植。21例（51%）患者根据指南接受了SAP。报告了13例术后感染，其中包括1例手术部位感染。对于10例（24%）患者，术中继续进行正在进行的抗菌治疗。未报告手术部位感染，仅报告了1例肺部感染。3例（7%）患者未给予SAP，记录到1例菌血症。3例（7%）患者在术中更改了正在进行的治疗。其中2例发生了肺部感染。其他患者因病情复杂进行了个体化评估。
这些初步数据显示ICU中SAP的管理存在很大异质性，表明需要基于临床试验的特定指南。
