Michigan Surgical Quality Collaborative, Ann Arbor, MI; Department of Chemistry, University of Michigan, Ann Arbor, MI.
Michigan Surgical Quality Collaborative, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI.
J Am Coll Surg. 2019 Nov;229(5):487-496.e2. doi: 10.1016/j.jamcollsurg.2019.07.011. Epub 2019 Aug 1.
Surgical site infections (SSIs) represent a significant preventable source of morbidity, mortality, and cost. Prophylactic antibiotics have been shown to decrease SSI rates, and β-lactam antibiotics are recommended by national guidelines. It is currently unclear whether recommended β-lactam and recommended non-β-lactam antibiotic regimens are equivalent with respect to SSI risk reduction in colectomy patients.
We conducted a retrospective cohort study of SSI rates between prophylactic intravenously administered recommended β-lactam and non-β-lactam in colectomy patients (25 CPT codes) collected by the Michigan Surgical Quality Collaborative from January 2013 to February 2018. Surgical site infection rates were compared as a dichotomous variable (no SSI vs SSI). Mixed-effects regression was used to compare the association between receiving a β-lactam or non-β-lactam antibiotic and likelihood of having an SSI.
Of 9,949 patients, 9,411 (94.6%) received β-lactam antibiotics and 538 (5.4%) received non-β-lactam antibiotics. Overall, there were 622 (6.3%) patients with SSIs. Of the patients receiving β-lactam antibiotics, SSIs developed in 571 (6.1%) compared with 51 (9.5%) patients in the non-β-lactam group. After applying mixed-effects logistic regression, prophylactic treatment with a non-β-lactam regimen was associated with significantly higher odds of surgical site infection (odds ratio 1.65; 95% CI 1.20 to 2.26; p < 0.01).
Colectomy patients receiving β-lactam antibiotics had a lower likelihood of SSI compared with those receiving non-β-lactam antibiotics, even when antibiotics were compliant with national recommendations. Our findings suggest that surgeons should prescribe β-lactam antibiotics for prophylaxis whenever possible, reserving alternatives for those rare patients with true allergies or clinical indications for non-β-lactam antibiotic prophylaxis.
手术部位感染（SSI）是发病率、死亡率和医疗费用的重要可预防来源。预防性抗生素已被证明可以降低 SSI 发生率，国家指南推荐使用β-内酰胺类抗生素。目前尚不清楚在结直肠切除术患者中，推荐的β-内酰胺类和推荐的非β-内酰胺类抗生素方案在降低 SSI 风险方面是否等效。
我们对密歇根手术质量协作组织（MSQC）在 2013 年 1 月至 2018 年 2 月期间收集的预防性静脉注射推荐的β-内酰胺类和非β-内酰胺类药物在结直肠切除术患者中的 SSI 发生率进行了回顾性队列研究（25 个 CPT 代码）。将 SSI 发生率作为二分类变量（无 SSI 与 SSI）进行比较。混合效应回归用于比较接受β-内酰胺类或非β-内酰胺类抗生素与发生 SSI 的可能性之间的关联。
在 9949 名患者中，9411 名（94.6%）患者接受了β-内酰胺类抗生素治疗，538 名（5.4%）患者接受了非β-内酰胺类抗生素治疗。总体而言，有 622 名（6.3%）患者发生了 SSI。在接受β-内酰胺类抗生素治疗的患者中，SSI 发生率为 571 例（6.1%），而非β-内酰胺类组为 51 例（9.5%）。应用混合效应逻辑回归后，预防性使用非β-内酰胺类方案与 SSI 的发生显著相关（比值比 1.65；95%CI 1.20 至 2.26；p < 0.01）。
与接受非β-内酰胺类抗生素治疗的患者相比，接受β-内酰胺类抗生素治疗的结直肠切除术患者发生 SSI 的可能性较低，即使抗生素符合国家推荐。我们的研究结果表明，只要有可能，外科医生就应该开β-内酰胺类抗生素进行预防，仅将替代方案用于极少数真正对β-内酰胺类抗生素过敏或有临床指征需要非β-内酰胺类抗生素预防的患者。
