Karaali Cem, Emiroğlu Mustafa, Çalık Bülent, Sert Ismaıl, Kebapci Eyup, Kaya Tayfun, Budak Gokcen G, Akbulut Gökhan, Aydın Cengiz
General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR.
Infectious Diseases, Sakarya University, Sakarya, TUR.
Cureus. 2019 Jun 1;11(6):e4793. doi: 10.7759/cureus.4793.
Introduction Although there are international guidelines for surgical antibiotic prophylaxis (SP), the use of inappropriate SP is still a common problem. Most studies investigated SP applications in clean and clean-contaminated cases. However, antibiotics in the discharge prescriptions of these cases have not been adequately investigated. In this study, we aimed to examine the antibiotics in SP applications and discharged prescriptions together and to find out the causes of inappropriate use. Materials and methods We retrospectively evaluated the data of patients admitted to our general surgery wards between 2014 and 2015. Patients with clean or clean-contaminated wound category operations were included. The patients were evaluated in terms of convenience of SP (choice of antibiotics, compliance with an indication for SP, timing of the first dose, SP>24 hours, and discharge prescription). In addition, to interpret the results, a questionnaire has been performed for the surgeons in the same clinics. Results A total of 1205 patients with clean and clean-contaminated wound class operation were enrolled in this study. The total accuracy rate of SP was 7.1%. SP application with the correct indication and timing of the first dose was compatible with guidelines: 55.6% and 81.9%, respectively. SP was applied >24 hours at 60.2% and antibiotic prescribing carried out after discharge at 80.6% of patients. According to questionnaire results, the use of SP over 24 hours and the prescription of antibiotics during discharge were: drain usage, hyperthermia, leukocytosis, surgeons feeling of comfort, avoidance of patients, and their relatives' reactions. Conclusion The total accuracy rate of SP rate was low in the present study and in surgeons prescribing the SP after discharge. In light of the present study, we suggest that discharge prescriptions should also be reviewed in clinics who have a high inappropriate surgical antibiotic prophylaxis rate.
引言 尽管有关于外科手术抗生素预防（SP）的国际指南，但不恰当使用SP仍是一个常见问题。大多数研究调查了清洁和清洁-污染手术中的SP应用情况。然而，这些手术出院处方中的抗生素使用情况尚未得到充分调查。在本研究中，我们旨在同时检查SP应用和出院处方中的抗生素，并找出使用不当的原因。
材料与方法 我们回顾性评估了2014年至2015年期间入住我院普通外科病房患者的数据。纳入进行清洁或清洁-污染伤口分类手术的患者。从SP的便利性（抗生素选择、符合SP指征情况、首剂给药时间、SP超过24小时以及出院处方）方面对患者进行评估。此外，为解释结果，我们对同一科室的外科医生进行了问卷调查。
结果 本研究共纳入1205例进行清洁和清洁-污染伤口分类手术的患者。SP的总准确率为7.1%。具有正确指征和首剂给药时间的SP应用符合指南：分别为55.6%和81.9%。60.2%的患者SP应用超过24小时，80.6%的患者出院后开具抗生素处方。根据问卷调查结果，SP使用超过24小时以及出院时开具抗生素处方的原因有：引流管使用、发热、白细胞增多、外科医生的舒适感、避免患者及其亲属的反应。
结论 本研究中SP率的总准确率较低，出院后开具SP的外科医生也是如此。根据本研究，我们建议在外科手术抗生素预防不当率较高的科室，也应对出院处方进行审查。
